Routine inspection·June 6, 2024

Licensing Program Analysts (LPAs) Jessica Cho and Michael Tea conducted an unannounced Required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPAs Cho and Tea met with Caregiver Rommel DivinaGracia and stated the purpose of the visit followed by Administrator Milany Mora. The facility is licensed to operate for six (6) non-ambulatory and maintains a hospice waiver of five (5). The facility is a single-story structure located in a residential neighborhood. LPAs toured the physical plant accompanied by Caregiver DivinaGracia at 2:15pm, and the following were observed: LPAs toured the inside and facility appeared clean, organized, and in sanitary condition. There are a total of six (6) resident and two (2) staff bedrooms. The resident bedrooms were appropriately furnished and the bedding in the resident bedrooms were in good condition. Adequate lighting was provided and storage for personal belongings were observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. There are a total of four resident bathrooms which measured at 122.3, 120.3, 128.0, and 129.4 degrees Fahrenheit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharp objects were stored and inaccessible to the residents. The kitchen was inspected and facility maintains a two-day supply of perishables and seven-day supply of non-perishable food. Medications were centrally stored however the locking mechanisms for the medication cabinets were not working properly. The facility has two fire extinguishers that are charged and serviced on 09/19/2023. Auditory devices and smoke/carbon monoxide detectors were tested and operational. The facility conducted a Fire/Safety Drill on 06/01/2024. A working telephone (949) 393-3120 remains available. First Aid Kit contained all the necessary elements. The 'See Something Say Something' Poster (PUB475) was maintained at 8.5"x11" however did not meet the required size of 20"x26." LPA toured the outside grounds. The exit gates were self-closing and self-latching. LPAs conducted a file review of six residents' files and two personnel files which were in order. LPAs conducted two staff interviews and five resident interviews. Medications were audited for six residents and discrepancies were noted for Resident #1 (R1) and Resident #2 (R2) at the time of inspection. The following items were advised: to repair the locking mechanism for the medication cabinets, obtain a PUB475 in the size of 20"x26," two out of the four bathrooms exceeded 120 degrees Fahrenheit, cameras observed in two resident bedrooms were removed during the visit, obtain a doctor's order for half rail for Resident #3 (R3), and to ensure medications prescribed by the doctor is accurately documented and updated as needed on the Centrally Stored Medication Destruction Record. Based on the LPAs' observations, deficiencies are being cited today as per the Title 22, Division 6, Chapter 8 of the California Code of Regulations. Advisory Notes are also being issued. An exit interview was conducted with Administrator Milany Mora, and a copy of this report along with the LIC809C, LIC809D, and the appeal rights were provided at the end of the visit.