Routine inspection·June 13, 2024

Licensing Program Analysts (LPA) Jerome Haley conducted an unannounced visit to the facility to complete the required Annual inspection. LPA Haley met with Licensee/Administrator Stella Ladaban and toured the facility. The facility has a capacity of 6, of which 5 can be non-ambulatory and 1 may be bedridden. The facility phone number 714.484.1493. Structure : The facility is one level structure with six bedrooms. Currently three bedrooms are being occupied by residents and 1 bedroom is being occupied by staff. Kitchen: Clean and organized. Sharps locked in a drawer. A perishable food supply was observed in the refrigerator and freezer. Non-perishable food supply was observed in the cabinets and in the pantry near the front door across from the kitchen. Stove/Appliances: There’s one stove with 4 burners and a warmer, a refrigerator, dishwasher, washer, and dryer. All appliances are clean. The top left burner on the stove does not light unassisted. The washer machine in the garage is not currently working. Toxins: All cleaning supplies and chemicals are locked under the kitchen sink. Medications, First-Aid Kit: Resident medications are locked in a close next to the front door. In the locked medication closet, a first aid kit with all the required elements was observed. Resident & Staff Files : The Resident and Staff Records are kept locked in the closet next to the front door with the medications and the first aid kit. Bedrooms: Resident bedrooms were clean, organized and were in compliance with regulation guidelines. Bathrooms: The bathroom has a working toilet, wash basin and shower. Grab bars were tightly secured to the wall. Hot Water : Hot water was measured at 110.1 degrees F. Continued on LIC809C Hygiene Supplies : The facility has an adequate supply of hygiene items on hand. Linens, Hygiene, Emergency Supplies: Additional linens for each resident are stored in the resident closet and dresser drawers. The facility has a large amount of non-perishable food items in the pantry and an emergency water supply in the garage. There are several solar powered lamps and a solar powered radio equipped with a cell phone charger for emergency use and a large supply of batteries in the medication closet. Emergency Evacuation Drills: The most recent evacuation drill was conducted January 16, 2024. Evacuation drills are conducted quarterly and the evacuation drill for the second quarter will be conducted before the end of the month. Medication Review: There are currently three residents in the facility and medication was reviewed for all three residents. Resident File Review: A file review was completed for all three residents. Staff File Review: 4 staff files were reviewed during the visit. Garage: The garage is clean and organized, and walk ways were free of obstruction. A washer and dryer was observed. Several cases of water, adult wipes, adult diapers, and several miscellaneous items are being stored in the garage. Backyard: Clean, organized and walkways are free of obstruction. There was a table with a sunshade and chairs. There is a locked storage shed used to store tools, additional adult diapers, a printer, wood, and gardening items. Both side exit gates are self-closing and self-latching. Smoke Detectors/Carbon Monoxide Detectors: Smoke detectors and the carbon monoxide detector tested operational. There’s a fully charged fire extinguisher mounted on the wall in the kitchen next to the dining table. Misc (P&I): N/A. The facility does not manage any of the resident’s money. Activities, Recreation, Reading Material, etc: Board games, and painting materials were observed in the living room area. Citation(s) & TV/TA: Citations will be issued for violations of Title 22 regulations observed during todays inspection. Exit Interview: Exit interview was conducted, and a copy of this report and appeal rights were provided to Administrator Stella Ladaban.