Routine inspection·March 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) Maria Tente was notified via telephone but could not arrive to assist with the inspection. LPA observed that Administrator Maria Tente has a valid Administrator certificate which expires on December 3, 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 two story home with five resident bedrooms, one of which is shared, three staff bedrooms, four resident bathrooms, two of which are shared, a living room, a dining room, a kitchen, and an attached two car garage. LPA accompanied by a care giving staff conducted a tour of the interior portion of the facility. On today's visit, LPA observed five residents in care, two of which are on hospice, and two care giving staff present. LPA observed residents relaxing in the living room as well as their respective bedrooms. 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 hallway closet. LPA inspected the four 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 108.1 and 113.3 degrees Fahrenheit. LPA observed that one of the shared resident bathrooms had a common wash cloth for all resident use. LPA observed the second story of the home to be for staff use only and to be off limits to residents in care. LPA observed all three staff bedrooms to be locked and inaccessible to residents in care. LPA observed the kitchen has a two day perishable and seven day nonperishable food supply on hand. CONTINUED ON LIC809-C LPA observed kitchen appliances to be clean and operational. The five burner gas stove lights unassisted. LPA observed that the lock on the kitchen cabinet where knives and sharps are being stored was inoperable at the time of visit making them accessible to residents in care. A fire extinguisher is located in the kitchen and it was observed to be charged and serviced on May 30, 2024. LPA tested the wired smoke detectors/carbon monoxide detectors which tested operational. LPA observed the facility has not conducted an emergency disaster drill. The centrally stored medication is kept in a locked cabinet in the kitchen. A First Aid kit is stored in the locked kitchen cabinet 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. The garage is used for storage and laundry. LPA observed chemicals and toxins to be stored in the locked garage. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA and the 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 gate on the north side of the facility is self-latching and can be opened in an evacuation. LPA observed a pool located in the backyard. The pool is adequately fenced and is kept locked for resident safety. LPA reviewed all five resident files. LPA observed that the facility did not have a Pre-admission appraisal on file for Resident #1 (R1), Resident #3 (R3), Resident #4 (R4), and Resident #5 (R5). LPA observed the facility did not have a Reappraisal on file for R1, R2, R3, R4, and R5. LPA observed that the facility did not have a Medical Assessment on file for R4 and R5. LPA reviewed all five residents’ medication and medication records. LPA reviewed three staff files. LPA observed that Staff #1 (S1), Staff #2 (S2), and Staff #3 (S3) did not complete the required annual training for the year of 2024. LPA observed that 0 out of the 3 care giving staff do not have a valid CPR training card on file. All staff are background cleared and associated to the facility. Based on today's observations, deficiencies are being cited per Title 22 of the California Code of Regulations. LPA spoke with Administrator Maria Tente via telephone who provided permission for Caregiver Felijun Casuyon to be the authorized representative since she could not arrive to assist with the inspection. An exit interview was conducted with the facility's authorized representative. A copy of the report and Appeal Rights were provided.