Routine inspection·March 10, 2025

Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by care giving staff after explaining the purpose for the visit. Administrator (AD) Mary Jean Catacutan was notified via telephone and later arrived to assist with the inspection. LPA observed that Administrator Mary Jean Catacutan has a valid Administrator certificate which expires on August 2, 2025. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for three. The facility is a two story home with five resident bedrooms, all of which are located on the first floor, two staff bedrooms, both are which are located on the second floor, three resident bathrooms, two of which are shared, a living room, a dining room, a kitchen, and an attached two car garage. LPA accompanied by the AD conducted a tour of the interior portion of the facility. On today's visit, LPA observed five residents in care, one of which is on hospice, and two care giving staff present. LPA observed residents relaxing in the living room and in their respective bedrooms. LPA observed the See Something, Say Something poster (PUB 475) mounted on a wall in the dining room. LPA inspected the five resident bedrooms, and they were observed to be free of any hazards. LPA observed the resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. All resident beds had clean linens and blankets. LPA observed additional linens to be stored in a hallway closet. LPA tested the signal system in each of the resident bedrooms which tested operational. LPA inspected the three resident bathrooms. Resident bathrooms are clean. Bathrooms are equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 105.8 and 110.6 degrees Fahrenheit. LPA observed the second floor to be for staff use only and off limits to residents in care. LPA observed staff bedrooms to be clear of hazards. LPA observed the kitchen has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. CONTINUED ON LIC809-C The four burner gas stove lights unassisted. LPA observed knives and sharps to be stored in a locked kitchen cabinet. LPA observed chemicals and toxins to be stored in a locked kitchen cabinet under the sink. A fire extinguishers is located in the entryway of the facility and it was observed to be charged and serviced as of February 6, 2025. LPA tested the individual smoke detectors which tested operational. LPA tested the individual carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on January 18, 2025. The centrally stored medication is kept in a locked cabinet in the kitchen. A First Aid kit was observed be stored in the locked kitchen cabinet and it was observed to have all the required components. LPA observed a fire place in the living room and it was observed to not be in operation at the time of visit. The door leading to the attached two car garage is kept locked and inaccessible to residents. The garage is used for storage and laundry. LPA observed chemicals and toxins to be stored in the locked two car garage. LPA observed additional linens and blankets to be stored in the garage. LPA observed the facility has a three day emergency food and water supply to be stored in the garage. LPA and the AD conducted a tour of the exterior portion of the facility. LPA observed the exterior portion to be clear of obstructions and hazards. LPA observed a shaded outdoor seating area with furniture for resident use. The perimeter gate on the north side of the facility is self-latching and can be opened in an evacuation. There are no bodies of water on the premises. LPA reviewed all five resident files. All the required documentation were present and current in the resident files reviewed. LPA reviewed all five residents’ medication and medication records. LPA reviewed four staff files. All staff are background cleared and associated to the facility. Based on today's observations, no deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Administrator Mary Jean Catacutan and a copy of the report was provided.