Routine inspection·October 25, 2024

On October 25, 2024, at 1:05pm, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and granted entry by Caregiver (CG) Daniela Usurelu. Assistant Administrator (AA) Kevin Surgent arrived to the facility around 1:15pm. The facility is licensed to operate for five (5) nonambulatory resident of which one (1) may be bedridden and have a hospice waiver for three (3) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: six (6) resident bedrooms, three (3) bathrooms, living area, dining area, kitchen, an outdoor covered seating areas, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with AA Surgent. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, and Resident Room 5. Bathrooms were found to be clean and operational. The water temperature measured at 116.6 degrees F to 118.3 degrees F. A comfortable temperature of 75 degrees F was maintained in the facility. LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food, and emergency supplies were stored in the garage. Emergency water was stored in the staff office. The facility has one (1) fire extinguisher that was charged, mounted in the living area, and inspected on August 13, 2024. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE) in the garage. All mandated inspection control posters were posted. The smoke detectors and carbon monoxide detectors were operable. A working telephone (714-970-8331) remains available. LPA Kim conducted an audit of six (6) resident files (R1-R6), staff files (S1-S3), and medication and medication administration review. LPA Kim conducted two (2) staff interviews and two (2) resident interviews. A Deficiency was cited during this visit as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights were provided to Assistant Administrator Kevin Surgent.