Routine inspection·February 25, 2025

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose of conducting the Required 1-Year annual evaluation using the Care Inspection Tool. LPA was greeted and granted entry by Caregiver Eric Fonseca and explained the reason for the visit. Approximately 10:15am, Administrator Harris Mendoza arrived. Administrator Daniel Rescia has a valid administrator's certificate expiring on December 13, 2025. The facility is a single story structure and is licensed to operate for six non-ambulatory residents, in which one may be bedridden. Facility maintains a hospice waiver for four residents. There are five residents in care with one resident under hospice and two caregivers on duty. There are five resident bedrooms and three resident bathrooms. There are two staff private bedrooms. All common areas were inspected including the the attached two car garage. The residents' bedrooms were appropriately furnished. Beds and bedding supplies were in good condition, adequate lighting was provided, sufficient storage space for each residents' personal belongings were observed. Bathrooms were found to be in compliance, clean, and operational. The hot water temperature measured at 107.7, 107.0, and 118.7 degrees Fahrenheit. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food available. The fireplace was properly screened. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction. One out of the two exit gates were not self-closing and self-latching. LPA observed sufficient seating and shading. The fire extinguisher was charged, mounted, and serviced on June 18, 2024. The auditory devices and smoke/carbon monoxide detectors were tested and operational, however the volume for one smoke detector in one resident's bedroom was not as audible in comparison to remaining smoke detectors. LPA observed sufficient emergency food/water/generator in the garage. Emergency evacuation drills are conducted quarterly. The first aid kit contains all necessary elements. The facility land line number, (714) 632-5813, was tested and remains available. The liability insurance is valid expiring on November 20, 2025. The 'See Something, Say Something' (PUB 475) poster was observed in the correct size in the entry way. LPA conducted a file review of all residents and two staff. Discrepancies noted. Two out of five residents did not have a current medical assessment and two staff did not have a TB test result on file. Medications were audited and no concerns noted. Interviews were conducted. The following items were addressed: to increase the volume for one smoke detector in the room of Resident #2 (R2), ensure one exit gate self-latches, obtain bed rail orders for R1-R3 & R5, obtain a current physician's report for R2 and R4, obtain Tuberculosis (TB) tests for Staff #1 (S1) and Staff #2 (S2), request in writing to update the current facility telephone number, amend the current Emergency Disaster Plan (LIC 610E) to have the same content, and to ensure annual dues are paid timely due May 23, 2025. Based on the observations made during today's visit, deficiencies are being cited. Advisory Notes (LIC9102s) are also being issued. An exit interview was conducted with Administrator Harris Mendoza, and a copy of this report (LIC809/LIC809-C), LIC809-Ds, LIC9102s, LIC811s, appeal rights, and a copy of the LIC610E were provided at the end of the visit.