Routine inspection·June 20, 2024

On June 20, 2024, at 1:05pm, 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 Assistant Administrator (AA) Maria Tavarez and explained the purpose of the visit. The facility is licensed to operate for six (6) non-ambulatory of which one may be bedridden and have a hospice waiver for four (4) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: five (5) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, living room, dining room, kitchen, detached 2-car garage, and an outside covered patio area. LPA Kim toured indoor and outdoor of the physical plant with AA Tavarez. 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, Resident Room 5, and Staff Room 1. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 111.3 and 114.0 degrees F. A comfortable temperature of degrees 71 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 family room. The facility has one (1) fire extinguisher that is charged and was serviced on March 4, 2024, and smoke/carbon monoxide detectors were operable. 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 May 21, 2024. A working telephone (562-296-8871) remains available. First Aid Kit contained all the necessary elements. LPA conducted an audit of resident files (R1-R6), staff files (S1-S7) and medication and medication administration review that were all in order and complete. LPA Kim conducted 4 resident interviews and 4 staff interviews. A technical violation was assessed during this inspection visit according to the California Code of Regulations (Title 22, Division 6, Chapter 8). An exit interview was conducted and a copy of this report along with the appeal rights (LIC 9058) were provided to Assistant Administrator Maria Tavarez.