Routine inspection·January 30, 2025

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting a Required – 1 Year Inspection. LPA met with Administrator (AD) Angelo Buenaventura and discussed the purpose of the inspection. LPA reviewed Infection Control requirements. At about 8:00AM, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following: Structure: facility is a 4-bedroom, 3-bathroom, one-story house with an attached garage that is used for storage. There is a back yard with a patio cover for the residents. LPA observed 2 staff and 5 residents present at the facility. Resident Bedrooms: the 4 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: there are no staff bedrooms. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested between 114 and 116 degrees F in the 2 resident bathrooms. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the hallway, after corrections. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are paid. At about 9:30AM, LPA reviewed 5 resident files and 3 staff files, interviewed 2 residents and 2 staff, and inspected medications for 5 residents. Facility does not handle resident money. CONTINUED During the inspection, LPA and AD observed the following: based on documents, the facility does not have an Infection Control Plan; based on observation, the facility's fire extinguishers were purchased in 2022 and have not been inspected since; based on observation, the licensee did not ensure toxins, including bleach, were inaccessible in the non-lockable garage; based on Guardian records and admission, Staff #1 (S1) Mileah L Evangelista has been working at the facility for over a year and is background cleared, but is not associated to the facility; based on documents, the licensee did not ensure 2 out of 2 staff had documented medication training; based on documents and admission, the licensee has not been conducting emergency disaster drills; based on observation and admission, Resident #1 (R1) had a full bedrail on their bed but is not on hospice; and based on admission and documents, the facility has a hospice waiver for 2 but currently has 3 residents on hospice. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.