Routine inspection·June 18, 2024

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1 Year Inspection using the Care Inspection Tool. LPA Cho was greeted and granted entry by Administrator (Admin) Arlene Mahinay and Caregiver Mario Mahinay. Admin Arya Maghbouleh arrived at the facility to assist with the inspection. The facility is a single story structure located in a residential neighborhood. Facility is licensed to operate for six (6) non-ambulatory of which all may be bedridden and maintains a hospice waiver for six (6). There is one (1) resident under hospice care during today's visit. LPA toured the interior and exterior portions of the facility. There are a total of six resident bedrooms and six resident bathrooms. There is also one staff bedroom and a private staff bathroom. LPA observed the facility to be clean and sanitary. The resident rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. A camera observed in the bedroom of Resident # 5 (R5) was removed during the visit. Smoke/carbon monoxide detectors and auditory exit alarms were tested and operational. LPA observed bathrooms to be in good repair, provided with handrails, and a non-skid floor mat. The hot water temperature measured at 116.6, 115.3, 118.2, 120.0, 120.0, and 118.9 degrees Fahrenheit in the resident bathrooms. Facility met the two day perishable and seven day non-perishable food supplies. LPA observed medications, toxins, and sharps were inaccessible to the residents. The four fire extinguishers were purchased on today's date. For the exterior portion, facility had sufficient seating and shading. The exit doors were self-closing and self-latching. LPA observed the emergency disaster supplies including food/water located in the garage. LPA observed the required "See Something, Say Something' (PUB475) poster in the required size. Administrators' Certificates for Kathy Maghbouleh expires on 12/06/24. Administrator Arlene Mahinay whose certificate expired on 08/15/23 provided proof of completed course work during the visit. LPA conducted an audit of six residents' files and two staff files. Discrepancies noted in the staff file as the records were not available for review. Staff and resident interviews were conducted. Medications were audited for six residents. No discrepancies noted. LPA consulted the following: to ensure R5 is afforded privacy in their personal bedroom, to obtain a doctor's order for the full rail for one resident, to obtain a Tuberculosis Test (TB) result for one resident, and to ensure personnel records are maintained for each employee. Based on the observations made during today's visit, deficiencies are being cited as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. See the attached LIC90999Ds. An exit interview was conducted with Administrators Arya Maghbouleh and Arlene Mahinay, and a copy of this report including the LIC809C, LIC809Ds, LIC811s, and the appeal rights were provided during this visit.