Routine inspection·January 16, 2025

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPA Tea was greeted and granted entry into the facility by Administrator (AD) Milany Mora and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents, with a hospice waiver for five and bed-ridden for all. Currently there are six residents, of which two are on hospice during today's visit. At around 9:18 AM, LPA Tea reviewed six resident files and one staff file. There were discrepancies noted in the review of resident and staff files. Administrator certificate expires on December 02, 2025. Last facility disaster drill was conducted on December 1, 2024. LPA Tea along with caregiver toured the facility around 10:00 AM. LPA toured the physical plant, checked food service, and the first aid kit. The facility is a single-story home that consists of 6 resident bedrooms, 2 caregiver rooms, 4 bathrooms, living room, dining room, kitchen, and attached garage. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms, and they are operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 116.6 degrees F and 114 degrees F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including bandages, dressings, tweezers, thermometer, and scissors. Kitchen was inspected. One of the burners of the kitchen stove was not working. LPA explained that it needs to be fixed or replaced. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen drawer. LPA also observed toxin substances to be locked and inaccessible to clients in care locked and secured in the garage. The fire extinguishers throughout the facility were fully charged. LPA toured the outside grounds and there is ample seating with shade and two exit gates on both sides of the facility are self-latching and operational. LPA observed emergency supplies, food and water supply in the garage. Annual Inspection continued on LIC809-C Facility provides activities based on resident interests. The residents watch play trivia and answer brain teaser questions, exercises, listen to music and watch television. At the time of annual visit, residents were seen reading and watching television and having lunch later on during the visit. LPA reviewed medication storage and administration. Medications are stored in a locked cabinet in the kitchen. Medications are being administered per physician order but not properly documented. LPAs interviewed residents regarding their quality of care and spoke to staff present regarding care provided. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Administrator Milany Mora and a copy of these reports were given to the facility along with a copy of the LIC 858; 859;809-D, 9102 and Appeal Rights.