Routine inspection·September 13, 2024

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit for the Required 1 Year Inspection. LPA explained the purpose of today’s visit, and was greeted and granted entry by Caregiver Carolyn Nuestro. Administrator (AD) Myrna Adriano arrived shortly after. For today’s visit, LPA observed a total of two residents in care and one staff member on duty. LPA observed the Administrator's Certificate for facility AD Myrna Adriano which expires on March 03, 2025. LPA Ramirez toured the interior and exterior portions of the facility with AD Adriano. The facility is a single level structure and is licensed for five non-ambulatory residents, of which four may be on hospice and one bedridden. There are a total of four bedrooms, of which three are resident bedrooms, and one private bedroom for staff. LPA Ramirez toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. There are a total of three restroom. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature tested between 112.8-114.2 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to residents in care. Fire extinguisher was charged and located by the laundry room. CONTINUED ON LIC809-C.. LPA observed the emergency disaster and evacuation plan which is located by the residents' bedroom hallway. Facility had back-up emergency food and water supply. LPA observed that First Aid Kit had all the required components. LPA observed that medications and toxins were locked and inaccessible to residents in care. For the exterior portion, LPA Ramirez observed a shaded area, patio furniture, and the grounds were free of any hazards. There is one gate in the backyard, which both is self-closing and self-latching. LPA observed a pool which fenced by a 5 feet height metal fence. LPA observed that the pool had no water. During today's visit LPA observed residents watching television in their bedroom. LPA reviewed two resident files and two staff files. LPA observed that one of two resident files did not have an Admission Agreement. LPA interviewed residents and staff present. For today's visit one deficiency was issued per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with AD Adriano. A copy of this report was provided at the time of exit.