Routine inspection·February 12, 2025

Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by caregiving staff after explaining the purpose for the visit. Administrator (AD) Mayla Mach was notified via telephone but could not arrive to assist due to being away on a vacation. LPA observed that Administrator Mayla Mach submitted a Administrator renewal application to the Administrator Certification Bureau (ACB) on November 18, 2024. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory and has a hospice waiver for three. The facility is a single-story home with six private resident bedrooms, one staff room, five resident bathrooms, two of which are shared, a living room, a dining room, a kitchen, and an attached two car garage. LPA accompanied by the caregiving staff conducted a tour of the interior portion of the facility. On today's visit, LPA observed five residents in care, four of which are on hospice, and two caregiving staff present. LPA observed residents relaxing in the living room as well as their respective bedrooms. LPA observed the See Something, Say Something poster (PUB 475) mounted on a wall by the entryway of the facility. LPA inspected all six resident bedrooms, and they were observed to be free of any hazards. LPA observed the resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. All resident beds had clean linens and blankets. LPA observed additional linens are stored in a hallway closet. LPA inspected the five resident bathrooms. Resident bathrooms are clean. Bathrooms are equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 118.5 and 119.1 degrees Fahrenheit. LPA observed the staff room is kept locked and inaccessible to residents in care. LPA observed the kitchen has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. The electric stove top is operational. CONTINUED ON LIC809-C LPA observed kitchen knives are stored in a locked kitchen cabinet. LPA observed chemicals and toxins are stored in a locked kitchen cabinet under the sink. A fire extinguisher is located in the kitchen, and it was observed the be charged and purchased on January 24, 2025. LPA tested the wired smoke detectors/carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on December 9, 2024. The centrally stored medication is kept in a locked closet in the resident hallway. LPA observed a First Aid kit is stored in the locked closet and it was observed to have all the required components. The door leading to the attached two car garage is kept locked and inaccessible to resident in care. LPA observed the garage is used for storage and laundry. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA and caregiver staff conducted a tour of the exterior portion of the facility. LPA observed the exterior portion to be clear of obstructions and hazards. LPA observed a shaded outdoor seating area with furniture for resident use. The perimeter gate on the north side and southside of the facility are self-latching and can be opened in an evacuation. There is a large pond located in the backyard. LPA observed the large pond to be adequately fenced and locked for resident safety. LPA reviewed all five resident files. LPA observed that the Reappraisals for Resident #1 (R1), Resident #2 (R2), Resident #3 (R3), Resident #4 (R4), and Resident #5 (R5) were outdated. LPA reviewed five residents’ medication and medication records. LPA observed that Resident #2 (R2) had a routine medication container that was empty ar time of visit. LPA observed that R2 did not receive the routine medication on 2/11/25 and 2/12/25 as a result. LPA reviewed three staff files. LPA observed that Staff #1 (S1) and Staff #3 (S3) did not receive the required annual training for the year of 2024. All staff are background cleared and associated to the facility. Based on today's observations, deficiencies being cited per Title 22 of the California Code of Regulations. LPA spoke with Administrator Mayla Mach via telephone who authorized caregiving staff to sign the report. An exit interview was conducted with an authorized facility representative. A copy of the report and Appeal Rights were provided.