Routine inspection·February 11, 2025

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA explained the reason for the visit. Facility has 4 bedrooms, 2 bathrooms, kitchen, dining room, living room, 2 car garage and 3 storage sheds in the backyard. Facility is licensed for 6 non-ambulatory residents with a hospice waiver for 4. LPA and staff toured the facility. The Administrator's certificate expires on August 2, 2025. LPA observed the See Something, Say Something poster (PUB 475) posted in the main entry way of the facility. LPA observed the living room has a fire place that is screened. LPA observed a wall outlet in the living room that did not have a protective plate over it, the outlet wires are visible. The living room has a TV, 4 reclining chairs, 1 chair and a love seat. LPA observed both bathrooms are clean and operational. Hot water measured 119.6 degrees Fahrenheit in both bathrooms. LPA observed all the resident rooms had the required furnishings. All bedrooms in the facility have an exit and have fire clearance for non-ambulatory residents. LPA observed that in bedrooms 3 and 4 the exit doors were locked and could not be opened by residents in case of an emergency. Staff unlocked the doors during the visit. LPA toured the kitchen. LPA observed a 2 day perishable and 7 day non-perishable food supply on hand in the kitchen. LPA observed the sharp objects are kept locked under the kitchen sink. LPA observed the cleaning supplies are kept locked in the garage. LPA observed medications are kept locked in the hall closet. LPA observed a 3 day emergency supply of food and water stored in the garage. LPA observed liquid cleaner stored outside of it's original container. Purple cleaner (Fabuloso) was stored in 3 Windex bottles and had no additional labels to identify their contents. Smoke/carbon monoxide detectors tested operational. LPA and staff toured the backyard. Both exit gates on each side of the house are operational. LPA inspected all 3 storage sheds. All 3 sheds are kept locked. LPA observed old furniture and supplies stored in the sheds. No bodies of water observed in the backyard. There is a table with an umbrella and chairs to sit outside. No obstacles or hazards observed in the backyard. LPA reviewed 6 resident records and medications. No discrepancies observed. LPA reviewed 2 staff files. Both staff members are background cleared and associated to the facility. Both staff have all the required training and no discrepancies observed in their files. Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809Ds. Immediate civil penalty is being assessed due to fire safety deficiencies. See LIC421IM. An exit interview was conducted and copies of this report, deficiency pages, civil penalty assessment, appeal rights, and cited regulations were provided to the facility representative.