Routine inspection·June 6, 2024

Licensing Program Analysts (LPAs) Michael Tea and Jessica Cho conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPAs Tea and Cho were greeted and granted entry into the facility by administrator, Raymond Mendoza and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents, with a hospice waiver for four. Currently there are five residents, of which two are on hospice during today's visit. LPAs Tea and Cho along with the Administrator toured the facility at 9:10 AM. LPAs toured the physical plant, checked food service, and the first aid kit. The home consists of 6 resident bedrooms, 1 staff bedroom, 5 full bathrooms, living room, dining room, and kitchen. LPAs observed smoke detectors/carbon monoxide in common areas and bedrooms and operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 105 degrees F to 105.9 F degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPAs observed sharps locked in a kitchen drawer. LPAs also observed toxin substances to be locked and inaccessible to clients in care locked and secured underneath the kitchen sink. The fire extinguisher in the kitchen was fully charged. Kitchen appliances are operational during today's visit. LPAs toured the outside grounds and there is ample seating with shade and the two exit gates on both sides of the facilities are self latching and operational. LPAs observed emergency food in the kitchen and water supply in the garage. Facility provides activities based on resident interests, in the form of outdoor activities such as going out for walks and doing exercises. Continuation of annual inspection on LIC809-C The residents watch television, listen to music, reading books and newspapers and completing puzzles. At 9:46 AM LPAs Tea and Cho reviewed five resident files and one staff file. There were discrepancies noted in the review of resident and staff files. Administrator certificate expired on Jan 14, 2024 however administrator has complied with all course work and is pending renewal at this time. At 10:18 AM LPAs reviewed medication storage and administration. Medications are stored in a locked cabinet. Medications are being administered per physician order. LPAs interviewed residents regarding their quality of care and spoke to staff present regarding care provided. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Raymond Mendoza and a copy of these reports were given to the facility along with a copy of the LIC 858; 859;809-D, 9102 and Appeal Rights.