Routine inspection·June 6, 2025

On June 6, 2025 at 10:15am, Licensing Program Analyst (LPA) Eboni Bentley arrived at the facility to conduct an unannounced required 1-Year annual visit using the CARE Inspection Tool. LPA announced self and stated the purpose of the visit to Caregiver (CG) Francis Fonseca and was granted entry. Administrator (AD) Rosa “Janeth” Figueroa was contacted by telephone, arrived at the facility a short time later, and was present throughout the inspection. Administrator certificate for Rosa Figueroa expires on September 8, 2025. There are six residents on census. One resident on Hospice and three with dementia currently living at the facility. During today’s visit, six residents and three staff are present. LPA obtained copies of pertinent documents for clients and staff, including facility records: resident/staff rosters, Personnel Record (LIC500), resident and staff records. The facility is a one story home licensed for 6 non-ambulatory residents and has a Hospice waiver for 4. There are 5 resident bedrooms, 4 bathrooms, a living room area, a kitchen, a dining room area, and attached two car garage. Around 11:00am, LPA conducted a tour of the facility with AD Figueroa and the following was observed: 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 temperatures measured between 101.3 degrees F. and 102.5 degrees F and a deficiency was cited. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. CONTINUE TO LIC 809-C PAGE Common areas were clean and clear of hazards, doorways were free of obstructions. Kitchen was inspected and found clean and sanitary. Perishable and non-perishable food supply were checked and adequately stocked at time of visit. LPA observed knives and sharps locked in a kitchen cabinet. LPA also observed toxin substances to be secured, locked and inaccessible to residents in the garage. Kitchen appliances were operational during today's visit. LPA toured the outside grounds and there is ample seating with shade and the exit gate is self-latching and operational. A carbon monoxide/smoke detector in the main hallway was tested and operational. Smoke detectors in five bedrooms were found non-operational and a deficiency was cited. The facility’s last fire drill was conducted on April 30, 2025. Emergency food and water supply observed in the garage. First aid kit had all the required elements. Three fire extinguishers are fully charged with a service date of June 4, 2024 and licensee confirmed vendor will service on June 9, 2025. A working telephone (714-964-6310) remains available, and the facility has a device that can be used for video teleconference purposes. Liability Insurance is effective June 26, 2024, through June 6, 2025 and licensee confirmed policy will be corrected to cover June 26, 2024, through June 26, 2025 LPA Bentley conducted an audit of five (5) resident files (R1-R5), five (5) staff files (S1-S5), and conducted three (3) staff interviews, and four (4) resident interviews. Residents’ medication was found locked, and a review of the Medication and Medication Administration Record (MAR) was conducted. Based on today’s observations, deficiencies are being cited and two civil penalties issued during this visit as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. An exit interview was conducted with administrator, Rosa Janeth Figueroa and a copy of this report LIC809, 809-C, LIC809-D, CP421 and appeal rights provided.