Routine inspection·February 6, 2025

Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by care giving staff after explaining the purpose for the visit. Administrator (AD) Johan Mathews was notified via telephone and later arrived to assist with the inspection. LPA observed that Administrator Johan Mathews has a valid Administrator certificate which expires on June 13, 2026. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents with a hospice waiver for six. The facility is a two story home with five resident bedrooms, one of which is shared, one staff room, two resident bathrooms, one of which is shared, a living room, a dining room, a kitchen, and an attached two car garage. LPA accompanied by the AD conducted a tour of the interior portion of the facility. On today's visit, LPA observed five residents in care and two care giving staff present. One resident was away at the time of visit. LPA observed residents relaxing in their respective bedrooms and in the dining room. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected the five 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 closet in a resident bedroom. LPA observed Oxygen signs posted in the appropriate areas. LPA inspected the two 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 111.7 and 119.6 degrees Fahrenheit. LPA observed the second story of the home is off limits to residents in care and is used for storage. 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. LPA observed kitchen knives are stored in a locked kitchen cabinet. CONTINUED ON LIC809-C A fire extinguisher is located in the kitchen and in a hallway on the second story of the home. Fire extinguishers were observed the be charged and serviced as of July 1, 2024. LPA tested the wired smoke detectors and carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on December 20, 2024. The centrally stored medication is kept in a locked closet in the kitchen. The First Aid kit is stored in the locked closet and it was observed to have all the required components. The door leading to the attached two car garage is kept locked and inaccessible to resident in care. The garage is used for storage and laundry. LPA observed chemicals and toxins to be stored in the garage. LPA observed the facility has an three day emergency food and water supply stored in the garage. LPA and AD 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 gates on the north side and southside of the facility are self-latching and can be opened in an evacuation. There are no bodies of water on the premises. LPA reviewed all six resident files. All the required documentation were present and current in the resident files reviewed. LPA reviewed six residents’ medication and medication records. LPA reviewed two 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. An exit interview was conducted with Administrator Johan Mathews and a copy of the report was provided.