Routine inspection·April 7, 2025

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1 at 1:45pm. During today’s visit, LPA met with Miriam Esquivel, Administrative Designee . At time of entry two residents were at Day Program and two were present in the facility. The facility is a three bedroom, two bathroom single story residence with an approved fire clearance of four ambulatory ; two non-ambulatory residents of which two are approved for hospice. The facility currently has a census of four residents in care. During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in two of two resident bathrooms, and testing auditory devices on all exits. The hot water temperature measured between 111.2 and 117.0 degrees Fahrenheit and all smoke detectors were operational . The fire extinguisher is charged and was serviced on March 7, 2025. The facility’s fire drill is scheduled for April 10, 2025 and was last done in December 2024. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand . Emergency supplies are stored in the living room LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. The First Aid Kit has all the required elements and facility has a First Aid book. LPA reviewed three of three staff training and fingerprint records and conducted a complete review of resident records. One of four resident files did not have an Admissions Agreement for this facility and had transferred (Continued on LIC 809-C) (Continued from LIC 809) from another facility under the same Licensee. An LIC 9102-TV will be given to update the Admissions Agreement for this resident to this location. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires May 9, 2026. LPA toured the exterior as the last resident returned home from Day Program. LPA noted there is only one gated entryway so residents can freely walk around the perimeter of the home. There are no hazards blocking exterior passageways and LPA observed a shaded patio area. The washer and dryer were located in the garage. LPA noted disinfectants were locked in a toxic chemicals cabinet. All sharps were secured in a locked box in the kitchen. All three resident bedrooms had the required furnishings. Two shared a bedroom, two have a private bedroom and there is an additional bedroom for staff with an exterior entrance. Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Miriam Esquivel, Administrator Designee and a copy of the report and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.