Routine inspection·February 3, 2025

Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit for the purpose of conducting the required annual inspection. LPA was greeted and granted entry by Administrator (AD) Michael Adams after explaining the purpose for the visit. LPA observed that Michael Adam's Administrator Certificate expired on July 24, 2024. However, LPA verified and confirmed that AD submitted his renewal application to the Administrator Certification Bureau (ACB) on 07/24/2024. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for two. The facility is a single-story home with three resident bedrooms, two of which are shared, one staff room, two resident bathrooms, one of which is shared, a living room, a dining room, a kitchen, and an attached three car garage. LPA accompanied by the AD conducted a tour of the interior portion of the facility. On today's visit, LPA observed four residents in care, none of which are receiving hospice care, and two staff present. LPA observed residents relaxing in dining room and in the living room. LPA observed the See Something, Say Something poster (PUB 475) mounted on a wall by the entryway of the facility. LPA inspected all three 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 observed that staff room is kept locked and inaccessible to residents in care. LPA inspected the two 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 110.3 and 114.6 degrees Fahrenheit. LPA observed the kitchen has a two day perishable and seven day nonperishable food supply on hand. CONTINUED ON LIC809-C LPA observed kitchen appliances to be clean and operational. The four burner gas stove lights unassisted. LPA observed kitchen knives are stored in a locked kitchen cabinet. A fire extinguisher is located in the dining room and it was observed to be charged and up to date on service. LPA tested the individual smoke detectors and carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on January 25, 2025. The centrally stored medication is kept in a locked kitchen cabinet. LPA observed a First Aid kit stored in the closet in the resident hallway. The First Aid kit was observed to have all the required components. The door leading to the attached three car garage is kept locked and inaccessible to resident in care. LPA observed the three car garage is used for storage and for laundry. LPA observed chemical and toxins to be stored in the garage. LPA observed the facility has a three day emergency water supply stored in the garage. LPA observed the facility does not have a sufficient three day emergency food supply on hand. LPA and AD 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 of the facility is self-latching and can be opened in an evacuation. LPA observed a pool located in the backyard which is adequately fenced and kept locked for resident safety. LPA reviewed all four resident files. LPA observed that the Reappraisals for Resident #1 and Resident #2 were outdated. LPA reviewed four residents’ medication and medication records. LPA observed that the facility did not have a record of centrally stored prescription medications for Resident #2. LPA reviewed two staff files. All staff are background cleared and associated to the facility. Based on today's observations, deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Administrator Michael Adams. A copy of the report was explained and Appeal Rights were provided.