Routine inspection·September 9, 2024

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation using the CARE Inspection Tool. LPA met with Administrator Cherry Aguila and explained the reason for the visit. Facility is licensed to serve six (6) non-ambulatory residents and maintains an approved hospice waiver for six (6) residents. There are four (4) residents in care during today's visit with two caregivers on duty. The Administrator's Certificate for Cherry Aguila expires on November 11, 2024. LPA conducted a tour of the physical plant. This is a two story home in a residential neighborhood. The first floor consists of five resident bedrooms and two resident bathrooms. The second floor consists of two bedrooms and one bathroom which is occupied by one live-in staff. The second bedroom and bathroom is unoccupied. Residents do not occupy the second floor. LPA inspected all common areas including the attached two car garage. LPA observed the floor, bathrooms, and kitchen drawers require a deep cleaning. The residents' bedrooms were appropriately furnished. Beds and bedding supplies were in good condition, adequate lighting was provided, sufficient storage space for personal belongings were observed. Bathrooms were found to be operational. The water temperature measured at 108.0 and 110.0 degrees Fahrenheit. Toxins, disinfectants, and medications were secured and inaccessible, however the sharps were unsecured in the oven as the locking mechanism for the knife drawer was not working properly at the time of inspection. Locking mechanism was repaired during the visit. LPA observed sufficient two day supply of perishables and seven day supply of non-perishable food. LPA toured the exterior portion of the facility. LPA observed the outdoor passageway free of obstruction. LPA observed sufficient seating and shading. There was no body of water. Several sheds in the yard were utilized as storage which were secured and inaccessible to residents. Facility maintains two fire extinguishers one on each floor. Last service date was on September 19, 2023. The auditory devices and smoke/carbon monoxide detectors were tested and operational except for one auditory device on the sliding door. LPA observed sufficient PPE and emergency disaster supplies including food/water in the garage. Emergency evacuation drills are not conducted quarterly and facility does not maintain a log documenting the drills. The first aid kit contains all necessary elements. LPA observed the required 'See Something, Say Something' (PUB475) poster in the correct size. Facility maintains a current liability insurance. A working facility telephone number, (714) 340-0754, remains available. The annual licensing fee of $495.00 was paid on September 8, 2024. LPA conducted an audit of four residents' files and two personnel files. Discrepancies were noted. Medications were audited for four residents. No discrepancies noted. Staff and resident interviews were also conducted. The following items were consulted with Administrator Aguila: to replace battery for one auditory device on the sliding door, label expiration dates for all dried food items, deep clean the pantry drawers, bathrooms, and the floor for both levels, repair the light in the stairway that was flickering, post "Oxygen In Use, No Smoking signs for one bedroom and on the main door, complete/organize resident/personnel records, ensure staff training records are completed and maintained, to ensure at least one on duty staff is CPR/First Aid certified, to conduct quarterly evacuation drills, and to maintain a log. Based on the observations made during today's visit, deficiencies are being cited as per the Title 22, Division 6, Chapter 8 of the California Code of Regulations. See the attached LIC9099-Ds. Advisory Notes are also being issued. An exit interview was conducted with Administrator Cherry Aguila and a copy of this report including the LIC9099-C & Ds, Advisories, and the Appeal Rights were sent via email at the end of the visit.