Routine inspection·January 17, 2025

Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by caregiver staff after explaining the purpose for the visit. Administrator (AD) Cristina Evangelista was notified via telephone and could not arrive to assist due to being at a doctor's appointment. LPA observed that Cristina Evangelista has a valid Administrator certificate which expires on May 24, 2026. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents with a hospice waiver for two. The facility is a single-story home with four private resident bedrooms, two staff bedrooms, three shared resident bathrooms, a living room, a dining room, a kitchen, a courtyard, and an attached two car garage. LPA accompanied by caregiver staff conducted a tour of the physical plant. On today's visit, LPA observed four residents in care, one of which is received hospice care, and three caregiver staff present. LPA observed residents eating their breakfast in the dining room as well as eating in their respective bedrooms. LPA observed the See Something, Say Something poster (PUB 475) mounted on a wall in the dining room measured 11 by 17 inches measured. LPA inspected the four resident bedrooms, and they were observed to be free of any hazards. LPA observed the resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. All resident beds had clean linens and blankets. LPA observed additional linens are stored in a hallway closet. LPA inspected the three shared resident bathrooms. Resident bathrooms are clean. Bathrooms are equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 109.5 and 118.4 degrees Fahrenheit. LPA observed the two staff bedrooms are kept locked and inaccessible to residents. LPA observed the kitchen has a two-day perishable and seven-day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. The four burner gas stove lights unassisted. CONTINUED ON LIC809-C LPA observed kitchen knives are stored in a locked kitchen cabinet. LPA observed cleaning supplies are stored in a locked kitchen cabinet under the sink.Fire extinguishers are located in the dining room and garage. Fire extinguishers were observed to be charged and purchased on January 10, 2025. LPA tested the wired smoke detector/carbon monoxide detector which tested operational. LPA observed the facility conducted their last emergency disaster drill on January 4, 2025. The centrally stored medication is kept in a locked storage cabinet in the kitchen. LPA observed the First Aid kit has all the required components. The door leading to the attached two car garage is kept locked and inaccessible to resident. The garage is used for storage and laundry. LPA observed chemicals and toxins stored in the garage. LPA observed the facility has an emergency food and water supply stored in the garage. LPA and caregiver staff conducted a tour of the exterior portion of the facility. LPA observed the exterior portion to be clear of obstructions and hazards. LPA observed a shaded outdoor seating area with furniture for resident use. The perimeter gate on the southside of the facility is self-latching and can be opened in an evacuation. There is a fountain located in the courtyard. The fountain is not in operation and is adequately fenced for resident safety. LPA reviewed the four resident files. All the required documentation were present and current in the resident files reviewed. LPA reviewed four residents’ medication and medication records. LPA reviewed the Personal and Incidental expense monies (P&I) records for four out of four residents. LPA reviewed six staff files. All staff are background cleared and associated to the facility. Based on today's observations, there are no deficiencies being cited per Title 22 of the California Code of Regulations. AD advised LPA via telephone that a caregiver staff had permission to sign the report. An exit interview was conducted with caregiver staff and a copy of the report was provided.