Routine inspection·May 13, 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 Administrator/Caregiver Maricel Guibilondo and explained the reason for the visit. Administrator (Admin) Guibilondo holds a valid certificate expiring on November 12, 2025. The facility is a single story structure and is licensed to provide services for age range 60 and over for six non-ambulatory of which 5 may be bedridden. A waiver was granted to provide hospice services to five residents at one time. During today's visit, there are four residents under hospice care and two staff on duty. LPA toured the physical plant with Admin Guibilondo. Facility is clean and operational with the exception of the keypad lock on the garage door. LPA observed six resident bedrooms/bathrooms. There is one additional staff bedroom and bathroom. Resident bedrooms had all required furnishings. Bathrooms were found to be in compliance, clean, and operational. The hot water temperature measured at 118.4, 117.5, 119.8, 118.5, 120.0, and 119.6 degrees Fahrenheit in the resident bathrooms. All common areas were inspected including the attached two car garage. LPA reviewed the Emergency Disaster Plan (LIC610E) and observed sufficient emergency food and water in the garage and kitchen pantry, however not all disaster supplies were obtained as noted on the LIC610E. 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 in the kitchen and garage. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction. The exit gates were self-closing and self-latching. LPA observed sufficient seating and shading. The fire extinguisher was mounted and serviced on September 12, 2024. The auditory devices and dual functioning smoke/carbon monoxide detectors were tested and operational. One detector was removed in the hallway by the room of Resident #7 (R7). Emergency evacuation drills are not conducted quarterly. Last drill was conducted on February 1, 2024. The facility land line number, (949) 397-9099, was tested and remains available. The Complaint Poster, 'See Something, Say Something,' (PUB 475) was available in the correct size and posted in the entry way. LPA conducted a review of all residents and two staff files. Discrepancies observed in staff/resident files as the health screening for one staff and Tuberculosis (TB) tests in one out of two staff and two out out of five residents were not completed, a doctor's order for the hospital bed and full bed rail for one hospice resident was not present at the time of the file review for Resident #6 (R6). No interviews were conducted as all residents were sleeping, and one staff interview was conducted. Medications were audited in three out of five residents. No discrepancies observed. The following items were addressed with the Admin: to repair the key padlock on the garage door, to reattach the smoke detector in the hallway by R7's bedroom, to amend the LIC610E and obtain disaster supplies noted on the plan, to obtain bed rail order for R6, to complete Health Screening (LIC503) and TB test for Staff #2 (S2) as well as R3 and R4. Based on the observations made during today's visit, deficiencies are being cited and Advisory Notes (LIC9102s) are also being issued. An exit interview was conducted with Administrator/Caregiver Maricel Guibilondo, and a copy of this report including the LIC809C, LIC809D, LIC9102s, LIC811s, and the appeal rights were provided at the end of the visit.