Routine inspection·October 31, 2024

On October 31, 2024, at 12:55pm, 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 was greeted and granted entry by Caregiver (CG) Czari Martinez and Assistant Administrator (AA) Rustan Domingo. The facility is licensed to operate for six (6) nonambulatory resident 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: six (6) resident bedrooms, two staff bedrooms, three (3) bathrooms, living area, dining area, kitchen, an outdoor covered seating areas, gated swimming pool, and an attached two-car garage. LPA Kim toured inside and outside of the physical plant with AA Domingo. There were no obstructions on the premises. Swimming pool is inaccessible by being surrounded by a fence and locked gate doors. 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. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, Resident Room 5, and Resident Room 6. Bathrooms were found to be clean and operational. The water temperature measured at 116.7 degrees F to 118.0 degrees F. A comfortable temperature of 73 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 safety drills are conducted monthly and last conducted on October 26, 2024. 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). All mandated inspection control posters were posted. The smoke detectors and carbon monoxide detectors were operable. A working telephone (714-710-6647) remains available, and the facility has a device that can be used for video teleconference purposes. Emergency food, emergency water, and emergency supplies were stored in the garage. The facility has one (1) fire extinguisher that was charged and mounted in the kitchen. Liability Insurance is effective 9/5/2024 and expires on 9/5/2025. LPA Kim conducted an audit of five (5) resident files (R1-R5), four (4) staff files (S1-S4), and medication and medication administration review. LPA Kim conducted two (2) staff interviews. Deficiencies were cited during this visit as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. A Technical Violation was issued at this visit. An exit interview was conducted, and a copy of this report and appeal rights were provided to Assistant Administrator Rustan Domingo.