Routine inspection·February 19, 2025

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPA Tea was greeted and granted entry into the facility by caregivers, Flordeliza Balabbo and Remedios De Leon Marquez and explained the reason for the visit. Licensee (LE) Evangeline Galvez arrived shortly to help assist with the visit. Facility is licensed for six non-ambulatory residents, with a hospice waiver for three. Currently there are four residents, of which two are on hospice during today's visit. Around 8:30 AM LPA reviewed four resident files and two staff files. Residents files and staff files contained all required documentation. Administrator certificate expires on July 4, 2025. LPA Tea along with LE Galvez toured the facility at 9:23 AM. LPA toured the physical plant, checked food service, and the first aid kit. The home consists of four resident bedrooms, three full bathrooms, living room, dining and kitchen area, and a caregiver area. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 106.5 F degrees to 108.8 F degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including dressing, bandages, tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen cabinet. LPA also observed toxin substances to be locked and inaccessible to clients in care underneath the kitchen sink. Fire extinguishers throughout the facility were fully charged. Kitchen appliances are operational during today's visit. Annual Report continuation on LIC 809-C LPA toured the outside grounds and there is ample seating with shade and one exit gate on the right side of the facility is self latching and operational. LPA observed emergency food and water supply. LPA Tea observed residents watching television, eating lunch and relaxing in their room. Activities for the resident's are limited due to the resident's physical condition, but sometimes the staff takes them out for a walk if they are able to. At 9:40 AM LPA reviewed medication storage and administration. Medications are stored in a locked closet by the living room. Medications are being administered per physician order. LPA interviewed residents regarding their quality of care and spoke to staff present regarding care provided. The following deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Licensee Evangeline Galvez and a copy of these reports were given to the facility along with a copy of the LIC 858; 859;809-D, and Appeal Rights.