Routine inspection·August 14, 2024

On August 14, 2024, at 2:25pm, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with House Manager (HM) Rosallie Gabriel and explained the purpose of the visit. Administrator (AD) Juhayna Diaz arrived at the facility around 4:00pm. The facility is licensed to operate for six (6) non-ambulatory and have a hospice waiver for four (4) residents. The facility is a two-story structure located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, five (5) staff bedroom, six (6) bathrooms, living room, family area, dining room, office, kitchen, attached 2-car garage, and 2 outside covered patio area. LPA Kim toured indoor and outdoor of the physical plant with Direct Care Staff (DCS) Benjie Corpuz. There are no obstructions or bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. All bedrooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, Staff Room 1, Staff Room 2, Staff Room 3, Staff Room 4, and Staff Room 5. Bathrooms were found to be within Title 22 regulations and were clean and operational. Bathroom water temperature measured at 105.4 degrees F in resident bathroom #1, and 105 degrees F in resident bathroom #2. A comfortable temperature of 76 degrees F was maintained in the facility. LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food, water, supplies are stored in the kitchen pantry. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). The facility conducts Fire/Safety Drill quarterly and was last conducted on February 10, 2024. A working telephone (714-312-0054) remains available. Fire extinguisher is mounted in the dining room, fully charged, and receipt showing it was purchased on March 21, 2024. Due to time constraint a continuation of this inspection will be conducted at a later date. LPA Kim will: 1) conduct record review for staff and residents, 2) Conduct interviews with staff and residents, 3) Test smoke detectors and carbon monoxide detectors, 4) Inspect First Aid Kit 5) and conduct a medication review at a later date. An exit interview was conducted and a copy of this report and was provided to Administrator Juhayna Diaz.