Routine inspection·January 8, 2025

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the annual required inspection. LPA was greeted and granted entry by staff. LPA met with Administrator Romualdo Amante and explained the reason for the visit. Administrator Mel Amante's Administrator's certificate expires on March 26, 2025. Facility is licensed for 6 non-ambulatory residents, hospice waiver for 2 residents. Facility has 5 bedrooms, 3 bathrooms, living room, kitchen, dining room, storage room, activity room/family room and an attached 3 car garage that is used for storage and kept locked. LPA and the Administrator toured the facility. LPA observed the See Something, Say Something poster posted in the main entrance of the facility. .LPA observed all 3 bathrooms are clean and operational. Hot water measured 115.1 degrees Fahrenheit in all 3 bathrooms. LPA observed a 2 day perishable and 7 day non-perishable food supply on hand in the kitchen. Medications are kept locked in a kitchen cabinet. Knives and sharp objects are kept locked in a kitchen drawer. Cleaning supplies are kept locked under the kitchen sink. The storage room is located next to the kitchen and is a pass through to the garage. The storage rooms has an exit door to the backyard. The storage room has boxes and furniture stored in such a way that access to the garage and exit door are blocked. It is not possible to walk through the storage room. LPA observed clean linens stored in the hall closet. LPA observed the 5 resident rooms are clean and have all the required furnishings. LPA observed 3 out of the 5 resident rooms did not have a smoke detector. The smoke detectors in the two other resident rooms and throughout the facility tested operational. The carbon monoxide detector in the entry way of the facility tested operational. LPA toured the backyard. No bodies of water observed. LPA observed both exit gates are operational. LPA observed a shaded patio with seating to sit outside. LPA reviewed 2 staff records, 6 resident records and medications. LPA observed that 3 out of 6 residents are on hospice and the facility has a hospice waiver for 2, facility is operating beyond the limits of the license. No other discrepancies noted. Deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. Civil penalty assessed on today's date. (SEE LIC 421IM) for citation (CCR) 87203 Fire Safety. An exit interview was conducted and a copy of the report provided along with appeal rights.