Routine inspection·February 20, 2025

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA were greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 4 residents and the home currently has 6 residents, with 3 residents on hospice. Administrators (ADs) Julius Sevilla and Sandy Sevilla arrived shortly to conduct facility tour. Licensee Andy Beach arrived later during the visit. LPA along with AD toured the facility at 9:45 AM. LPA toured the physical plant, checked food service, facility documentation and the first aid kit. The home consists of 6 resident bedrooms, living room, dining room, staff room and kitchen as well as 7 bathrooms. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 112.2 degrees F and 118 degrees F in all bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Auditory exit alarms were operational during today's visit. LPA toured the kitchen at 9:50am and observed sharps unlocked in a slightly ajar drawer in the kitchen unsupervised during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. At 10:20am, LPA observed laundry detergent in an unlocked cabinet by the washer and driver and on the floor. LPA observed opened bottles of drinking alcohol and milk of magnesia in an unlocked refrigerator in the garage. The door access to the garage in unlocked. Prescription toothpaste was observed in resident 2's bathroom. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. The last disaster drill was conducted on 5/21/2024. Outside grounds were toured. One out of two exit gate walkways has gravel on the path throughout. Exit gates are unlocked and operational. CONTINUED ON LIC 809C DATED 2/20/2025. There are no security bars or weapons on the premises. First aid kit contained all required items except tweezers. Facility conducts activities in the form of exercise. There is shaded outdoor seating for residents. LPA observed the emergency food and water supply. LPA reviewed six resident files and two staff files. All resident files contained required documentation including admission agreements, physician reports, and resident appraisals. Staff files reviewed contained required documentation including required annual training, medical assessment/ TB, criminal record clearance and proof of CPR training. LPA reviewed medication storage and administration. Medications are stored in a locked cabinet. Medications are being administered per physician order. Some medications were observed stored in a daily pill box. Based on the observations made during today’s visit, the following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided along with appeal rights.