Routine inspection·June 3, 2024

On today's date, Licensing Program Analyst (LPA) LPA Rosie Quiroz made an unannounced visit on this day for the purpose of conducting an Annual Required-1 year inspection visit. LPA was greeted by Administrator (AD) LIsa Encarnacion and discusses purpose of today's visit. Licensee (L) Joey Encarnacion arrived during today's visit The facility is a one story home which consists of: 2 shared resident bedrooms, 2 private residents bedrooms, 2 caregiver bedrooms, 3 bathrooms designated for residents, 1 bathroom designated for visitors and staff, living-room, family room, kitchen with dining area, back yard with ample shade and outdoor furniture, garage with operational washer and dryer. The facility is licensed for age range 60 and over, approved for capacity of 6 Non-Ambulatory residents and has a hospice waiver for five (5) residents. There are currently (4) one resident receiving hospice care services. (AD) Lisa Encarnacion has a current Administrator's certificate which expired 3/5/2023. (AD) Lisa Encarnacion indicated completed AD renewal, pending certificate and agreed to submit copy of AD Certificate to CCLD upon receiving. LPA along with AD Lisa Encarnacion toured the interior and exterior of facility. LPA observed kitchen for proper sanitation and cleanliness. LPA observed sharp objects locked and secured in cabinet in kitchen area, and observed toxin substances to be locked and inaccessible to residents in care in locked and secured closet in garage area. The food was observed to meet the minimum requirement of two days perishable and seven days nonperishable food supply for residents in care. Resident bedroom areas were observed to have required furnishings including but not limited to: lamp, bed, mattress, night stand and clean linen. LPA interacted and interviewed with residents and staff during today's facility tour. The water temperature in resident bathrooms were measured to be within normal limits. The Grab bars and non-slip mats were observed in resident bathrooms and shower room. Room temperature inside the facility was recorded to be 72 degrees F. The outside grounds were inspected during facility tour, and no bodies of water were observed. No pool available at this facility. CONTINUE LIC 809-C PAGE... CONTINUED... Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. LPAs observed and tested functional and operational carbon monoxide and smoke alarms. LPA Quiroz observed two fire blankets. (L/AD) Joey Encarnacion reports fire drills are conducted quarterly with staff and residents. Last facility fire drill was conducted on 1/5/2024. LPA Quiroz reviewed whether the facility is operating within capacity limitations and reviewed repeated violations, no repeated violations assessed. During today's visit, LPAs reviewed six of six resident records, centrally stored medications and four personnel files. Resident and personnel files were found to be within Title 22 California Code of Regulations. Based on the observations made during today’s visit; there are no deficiencies being cited per Title 22 Division 6 of the California Code of Regulations. This report was read and reviewed with L/AD Joey Encarnacion, and a copy of this report, LIC 858s, LIC 859 were provided at exit.