Routine inspection·January 13, 2025

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual inspection using the CARE Inspection Tool. LPA was greeted and granted entry by House Manager (HM) Concepcion Jimenez after explaining the purpose of the visit. Administrator (Admin) Lisa Gaitan arrived and assisted with the inspection. The facility is a single story structure located in a residential neighborhood. Facility is licensed to operate for six (6) non-ambulatory and maintains a hospice waiver for four (4) residents. There are three residents in care during today's visit with one caregiver and HM on duty. LPA observed the facility to be clean and sanitary. There are six resident bedrooms and two resident bathrooms. One additional bedroom is occupied by the HM who is a live in staff. All common areas were inspected including the attached two car garage and office/medication room. The residents' bedrooms were appropriately furnished. Beds and bedding supplies were in good condition, adequate lighting was provided, sufficient storage space for each residents' personal belongings were observed. Bathrooms were found to be in compliance, clean, and operational. The water temperature measured at 108.6 and 109.2 degrees Fahrenheit. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food available. 18 non-perishable food items were observed expired and were immediately discarded during the visit. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction. The exit gate was self-closing and self-latching. LPA observed sufficient seating and shading. Facility maintains a fire extinguisher which was observed mounted, charged, and serviced on October 1, 2024. The auditory devices and smoke/carbon monoxide detectors were tested and operational except for one auditory device in one out of the six resident bedrooms. In the same resident bedroom, the screen door handle was loose and a tear was present on the screen sliding door. LPA observed some of the emergency disaster supplies including food/water in the office/medication room. However, the generator, portable radios, and etc. were not maintained by the facility as indicated on the Emergency Disaster Plan (LIC610E). Emergency evacuation drills are being conducted quarterly. The first aid kit contains all necessary elements. The first aid manual was not current which was published in 2006. The facility land line number, 949-859-5113, was tested and remains available. The liability insurance is also current. LPA observed the required 'See Something, Say Something' poster (PUB475) framed in an incorrect size in the living room. The Administrator's Certificate for Luis Gaitan expires on May 6, 2025. LPA conducted an audit of three residents' files and one personnel files. Discrepancies were noted in one staff file as the Tuberculosis (TB) test results were not present. Medications were audited for three residents. No discrepancies noted. Staff and resident interviews were conducted. The following items were noted and discussed with Admin Lisa Gaitan and HM Jimenez: to enlarge the complaint poster in the correct size and to post it in the entry way, to obtain a current first aid manual, generator, portable radios, and etc, to repair one auditory device, screen, and sliding door handle in one resident's room, clean out pantry and the food crumbs on the canned food, and to label the expiration dates, and to obtain the TB Test results for one staff. Admin was also reminded to ensure timely payment of the annual licensing fee due January 20, 2025. Based on the observations made during today's visit, deficiencies are being cited today. Advisory Notes are also being issued. An exit interview was conducted with Administrator Lisa Gaitan and House Manager Concepcion Jimenez, and a copy of this report and the LIC809-D, and LIC9102s were provided at the end of the visit.