Routine inspection·February 5, 2025

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Administrator Hermelinda Perez was notified of the visit via telephone and arrived shortly afterwards to assist with the visit. There are currently five residents in care, three of which are currently receiving hospice care after one resident alternated from her admission into palliative care. LPA observed residents relaxing in their respective bedrooms or in the facility's common living areas. LPA accompanied by facility staff toured the physical plant. The facility is a two-story house with an attached garage. The second level is for use by the licensee and their family exclusively, with all family members over 18 shown to be background cleared. The facility has one private bedroom and two shared rooms . There are two full bathrooms throughout the facility, one designated for use by residents and the other one for staff, visitors and third-party providers. Bedrooms appeared clean and sanitary. Two beds are equipped with full rails and one bed with half rails. Physician orders and hospice plans of care for all postural supports in use reviewed. LPA observed all the resident bedrooms have the required furnishings. Bathrooms appear clean and sanitary. Bathroom are equipped with grab bars and slip mats. Hot water temperature measured at 113.2F in the bathroom used by residents. LPA observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items are stored in a secure drawer. Fire extinguisher is charged and mounted, with up-to-date maintenance documented on an attached receipt. LPA tested the smoke and carbon monoxide detectors which were found to be operational. The centrally stored medication is located in a secure closet located in the dining area. The attached garage is inaccessible to residents and is used for storage and laundry, with an additional refrigerator/freezer present. Cleaning supplies are stored securely in the garage. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 LPA and facility staff toured the outside of the facility. LPA observed an shaded outdoor seating area with furniture for resident use. The perimeter gate on one side of the property is self-latching and can easily be opened in an evacuation. There is a fully fenced swimming pool on the premises which is kept inaccessible to residents. LPA reviewed five resident records which included all necessary components. LPA reviewed resident medication records and prescription orders with no discrepancies observed. One resident interview conducted during the visit. There are no bedridden residents present on the premises. LPA reviewed two staff records which were found to be complete with the exception of the most recent annual training which was verified to have been conducted but was not documented by the administrator. Consultation provided. CPR/First aid training reviewed and up-to-date. All staff are background cleared and associated to the licensed location accurately. Licensee does not hold a current liability insurance at the time of the visit after encountering issues during their renewal. Licensee states a new insurance coverage is in the process of being acquired within the next two weeks. Type B citation issued. Based on the observations made during today’s visit, one type B deficiency is being cited per Title 22 Division 6 of the California Code of Regulations and three consultations are provided. An exit interview was conducted and a copy of this report along with appeal rights was provided to a facility representative.