Routine inspection·January 15, 2025

Licensing Program Analyst (LPA) Brandon Lopez and Licensing Program Manager (LPM) Sheila Santos made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by caregiver staff after explaining the purpose for the visit. Administrator (AD) Maria Jimenez was notified via telephone and later arrived to assist with the inspection. LPA observed that Administrator Maria Jimenez has a valid Administrator certificate which expires on April 20, 2025. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents with a hospice waiver for two. The facility is a two story home with three resident bedrooms, two staff bedrooms, two resident bathrooms, a living room, a dining room, a kitchen, and an attached two car garage. The upstairs portion of the facility is designated for staff only. LPA and LPM, accompanied by the caregiver staff conducted a tour of the physical plant. On today's visit, LPA observed four residents in care and three caregiver staff present. LPA observed the See Something, Say Something poster (PUB 475) mounted on a wall by the kitchen. The PUB 475 poster measured 9 by 14 inches. LPA inspected the 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. Resident linens and blankets were clean. LPA observed additional linens are stored in a hallway closet. LPA inspected the two shared bathrooms. Resident bathrooms are clean. Bathrooms are equipped with grab bars and non skid floor mats. LPA observed that three toxins were stored in an unlocked cabinet in resident bathroom one. LPA observed that one toxin was located in an unlocked cabinet in resident bathroom two. Caregiver staff immediately removed the chemicals and locked it. Hot water temperature measured between 108.1 and 108.9 degrees Fahrenheit. LPA inspected the staff bedroom which was observed to be locked. LPA observed the upstairs staff bathroom to be unlocked. LPA observed six chemical products that were observed to be stored in the staff bathroom. Caregiver staff immediately removed the chemicals and locked it in the staff bedroom. CONTINUED ON LIC809-C LPA observed the kitchen has a two day perishable and seven day non perishable food supply on hand. LPA observed kitchen knives are stored in a locked kitchen cabinet. LPA observed cleaning supplies are stored in a locked kitchen cabinet under the sink. LPA observed that three out of the five burners on the gas stove are not in operation. A fire extinguisher is located in a hallway by the kitchen and it was observed the be charged but does not have a maintenance tag. LPA tested the individual smoke detectors/carbon monoxide detectors which tested operational. The centrally stored medication is kept in a locked cabinet by the kitchen. LPA observed the First Aid kit has all the required components but facility does not have a First Aid manual. The door leading to the attached garage was unlocked at the time of visit. The garage is used for storage and laundry. LPA observed chemicals and toxins to be stored in the garage. LPA observed the facility has an emergency food and water supply stored in the garage. LPA and LPM, accompanied by caregiver staff conducted a tour of the exterior portion of the facility. LPA observed one pipe, construction materials, three buckets, two trash boxes, and concrete blocks left unattended that may pose a safety issue. LPA observed one ladder was left unattended by the shed. Caregiver staff immediately removed the ladder and locked it in the garage. LPA observed a shaded seating area with furniture for resident use. There is a pool located in the exterior of the facility. The pool is inaccessible to residents and observed to be adequately fenced. LPA reviewed the four resident files. All the required documentation were present and current in the resident files reviewed. LPA reviewed four residents medication and medication records. LPA reviewed three staff files. LPA observed that Staff #2 (S2) and Staff #3 (S3) are not associated to the facility. Civil penalties assessed. LPA observed that the facility does not have any record of an emergency disaster drill in the last quarter. LPA observed the facility does not currently have liability insurance. Based on today's observations, the facility is being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Administrator Maria Jimenez. A copy of the report was explained and Appeal Rights were provided.