Routine inspection·March 25, 2025

Licensing Program Analyst (LPA) Nancy Guillen made an unannounced visit for the purpose of conducting a required annual Inspection. LPA was greeted and granted entry by care provider Ace Reblora after explaining the purpose of the visit. Administrator (AD) Carina Demman was notified via telephone and later arrived to assist with record review. LPA observed the Administrator certificate was current and expires December 12, 2025. This is a Residential Care Facility for the Elderly (RCFE) licensed to six non-ambulatory residents with a hospice waiver for three. The facility is a one story home with three resident bedrooms, one staff bedroom, two bathrooms, kitchen, living room, dinning room, office space, and an attached garage. During the inspection, LPA and caregiver conducted a tour of the inside and outside of the facility and observed the following: LPA observed residents watching television in the living room. LPA observed four residents in care and three staff present. LPA observed the See Something Say Something Poster (PUB 475) mounted on the wall by the facility entrance. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets with additional linens stored in the hallway storage cabinet. LPA observed bathrooms were clean and equipped with grab bars and non skid floor mats. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 106.7 and 109.5 degrees Fahrenheit. LPA toured the outside of the facility and observed outdoor passageways were free of obstruction. LPA observed the backyard had a shaded sitting area with furniture for resident use. Continued on LIC 809C LPA observed the facility had a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be last purchased on June 29, 2023; a deficiency was cited on today’s date. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. The garage is used for storage and inaccessible to residents. Toxic chemicals, cleaning solutions, and disinfectants were observed throughout the facility. Toxins/cleaning supplies were observed under bathroom sink, hallway closet, and outdoor patio. Kitchen cabinet was also observed to be used for additional medication storage and did not have a locking mechanism and knives were observed in an unlocked cabinet accessible to residents in care; a deficiency was cited on today’s date. Medication was observed in the office space of the facility however, medication is pre-poured a week in advanced in a weekly container; a Deficiency was cited on this date. LPA observed the First Aid Kit had all the required components. LPA observed disaster drills are not logged and was unavailable for review; a deficiency was cited on today’s date. While waiting for the AD, LPA began review of the records. LPA Guillen reviewed four resident records. All the required documentation was present and current in the residents’ files reviewed, however Resident 1 and Resident 2 did not have doctor’s orders present for hospital bed and rails at the facility for review; a deficiency was cited on today’s date. LPA reviewed two employee records. All employee’s present have a criminal record clearance and were associated to the facility. LPA observed records reviewed have a current First Aid certificate. Staff #2 however did not have yearly training completed, a deficiency was cited on today’s date. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report, LIC 809D and appeal rights was left at the facility.