Routine inspection·June 17, 2024

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1 Year Inspection. LPA Cho was greeted and granted entry by Caregiver Clemenciaa Ayala Vasquez followed by a second Caregiver in training, Zindy Carolina Pena Sarabia. Administrators (Admins) Jose and Maria Jimenez were not present as they were out of town. Admin Jose was advised of the visit by telephone at 9:33am. Facility Consultant Efrain Matheus arrived to assist with the inspection. The facility is a two-story structure located in a residential neighborhood. Facility is licensed to operate for five (5) non-ambulatory and maintains a hospice waiver of four (4). There is one (1) resident under hospice care during today's visit. LPA Cho toured the interior and exterior portions of the facility. There are a total of three resident bedrooms and two resident bathrooms on the first floor. The second floor is the residence of the Administrator's family. LPA observed the facility to be clean and sanitary. The resident rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of of tripping hazards. Smoke/carbon monoxide detectors and auditory exit alarms were tested and operational. LPA observed bathrooms to be in good repair, provided with handrails and a non-skid floor mat. The hot water measured at 113.1 and 113.7 degrees Fahrenheit in the resident bathrooms. Facility met the two day perishable and seven day non-perishable food supply. LPA observed medications, toxins, and sharps were inaccessible to the residents in care. The fire extinguisher was purchased on 11/22/23. For the exterior portion, facility had sufficient seating and shading and the exit door was self-latching and self-closing. LPA observed the emergency disaster supplies including food/water in the garage. Facility did not maintain an emergency drill log. LPA observed the required "See Something, Say Something' (PUB475) posters. LPA conducted an audit of four residents' files and one staff file. LPA did not conduct a staff interview due staff being occupied. No resident interviews were conducted as residents were also occupied. Medications were audited for four residents. No discrepancies noted. LPA consulted the following: to ensure staff/volunteers/facility representative is fingerprint cleared and associated and to maintain a quarterly emergency drill log accounting for various emergency scenarios. Based on the observations made during today's visit, a deficiency is being cited as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. An immediate civil penalty is being assessed. An Advisory Note (LIC9102) is being issued during the visit. An exit interview was conducted with Facility Consultant Efrain Matheus per the acknowledgement of Administrator Jose Jimenez, and a copy of this report including the LIC809C, LIC809D, LIC421BG, LIC811, and the appeal rights were provided during this visit.