Routine inspection·February 21, 2025

On February 21, 2025, at 1:20pm, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and granted entry by Administrator (AD) Yvonne Isackson. The facility is licensed to operate for six (6) nonambulatory residents and has a hospice waiver for two (2) residents. The facility is a two-story structure located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, four (4) staff bedrooms, four (4) bathrooms, living area, dining area, kitchen, outdoor covered patio, shed in the backyard, and a detached two car garage. LPA Kim toured inside and outside of the physical plant with AD Isackson. There were no bodies of water or obstructions in the facility. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Resident Room 4. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 108.5 degrees F to 114.9 degrees F. A comfortable temperature of 72 degrees F was maintained in the facility. LPA Kim observed the facility to be appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food both were available and maintained properly. Emergency food, emergency water, and emergency supplies are stored in the garage. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The smoke detectors and carbon monoxide detectors were operable. A working telephone (562-296-5410) and video teleconferencing device dedicated to the residents both remain available. Last emergency drill was conducted on December 2, 2024. First aid kit is maintained and contains all the necessary elements. LPA Kim conducted an audit of resident file (R1), staff files (S1-S4), and medication and medication administration record were in all in order and complete. LPA Kim conducted one (1) resident interview and two (2) Staff interviews. No deficiencies were cited during this visit. An exit interview was conducted, and a copy of this report was provided to Administrator Yvonne Isackson.