Routine inspection·July 5, 2024

On July 5, 2024, at 8:00am, 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 Administrator (AD) Nicoloae Gavrias and explained the purpose of the visit. The facility is licensed to operate for four (4) non-ambulatory of which one (1) may be bedridden and have a hospice waiver for two (2) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: three (3) resident bedrooms, two (2) bathrooms, living room, dining area, kitchen, attached 2-car garage, and an outside covered patio area.` LPA Kim toured indoor and outdoor of the physical plant with AD Nicolae Gavrilas. 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, and Resident Room 3. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 112.8 degrees Fahrenheit in bathroom 1 and 115.5 degrees Fahrenheit in bathroom 2. A comfortable temperature of 76 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 garage. The facility has one (1) fire extinguisher that is charged and smoke/carbon monoxide detectors were operable. A working telephone (714-777-7030) remains available. First Aid Kit contained all the necessary elements. 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). LPA conducted an audit of resident files (R1-R3) and medication and medication administration review that were all in order and complete. LPA Kim conducted 2 resident interviews and 2 staff interviews. A Technical violations 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 were provided to Administrator Nicolae Gavrilas.