Routine inspection·August 12, 2024

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the Required Annual Inspection. LPA was greeted and granted entry by facility caregivers after introducing himself and stating the reason of the visit. Licensee Salvador Diaz and administrator Jennifer Perez were notified by phone and arrived later to assist. During the inspection, LPA and facility staff conducted a tour of the physical plant and observed the following: The facility is a one story home with two private and two shared bedrooms and one staff room in addition to the facility's common living areas and two shared bathrooms. All resident bedrooms have the required furnishings. LPA observed all beds have linens and blankets. Postural supports observed in one room with corresponding physician orders verified to be on file. There are currently six residents admitted to the facility with two receiving hospice care. Residents are observed to be clean and appear well taken care of. Bathrooms faucets and toilets are operational. Water temperature was verified to be within acceptable range. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. A fire and emergency drill was conducted in July 2024 along with an update of emergency supplies but was not documented at the time. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food. Smoke and carbon monoxide detectors tested operational. Fire extinguisher present are observed to be fully charged. There is adequately shaded outside space with outdoor furniture present. There are self-latching gates on both sides of the house and routes of egress are free of obstructions. There is a pool present in the backyard with adequate fencing confirmed to be present. Residents are encouraged to use the pool under staff supervision. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 Medication, sharp items and cleaning supplies were confirmed to be inaccessible throughout the physical plant. The medication central storage was also observed to be secure and reviewed for accuracy during the visit. LPA reviewed six resident files and two staff files. One medical assessments for a resident with an indication of dementia were found to be outdated and will need an update. One staff health screening form is observed to be blank. Admission agreements signatures are incomplete in several forms and corrected during the visit. Based on the observations made during today’s inspection, two type B deficiencies and seven advisory notes are being issued per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report along with appeal rights was left at the facility.