Routine inspection·August 4, 2022

Licensing Program Analyst (LPA) Edward Tapia made an unannounced required annual inspection in this facility. LPA met with staff Rentato Arcinas Chavez and stated the purpose of this visit. Administrator Maria “Pricilla” Mirabueno arrived during the inspection to provided assistance. The facility is a single level structure and licensed for six non-ambulatory with a hospice waiver for six. This facility is a Residential Care Facility for the Elderly/Dementia. At about 10:15 AM, LPA Tapia was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure. For this visit, LPA observed 4 residents in care and 2 staff members on duty. LPA reviewed the facility Personnel Report and notice Rentato Arcinas Chavez not associated. Administrator provided proof of association on 08/04/2022. Administrator also provided copies of LIC9182 and LIC 508 for Gerald Paulo Chavez. LPA informed Administrator to associated individual immediately. LPA toured the interior and exterior portions of the facility. There were 4 resident rooms of which 1 was a shared room, 2 were a private rooms and 1 was a vacant room. There was a private staff room and restroom. Resident rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Manual smoke detectors and carbon monoxide alarms were tested to be operational. Bathroom (1) was observed to be in good repair and provided with grab bars and hot water was measured at 105.2 degrees Fahrenheit. Facility met the minimum two-day supply of perishable and seven-day supply of non-perishable food stock requirements, cleaning supplies and sharp items were inaccessible to residents in care. Facility had adequate supplies of personal protective equipment in place. Fire extinguisher was observed mounted. For the exterior portion, facility had outside furniture in good repair; and grounds were free of tripping hazards. Garage is kept locked and used for storage. LPA did observe another staff member in the garage. Kitchen was in good repair with sharp items kept locked. LPA did notice medication in the refrigerator. Administrator immediately locked medication away. LPA did inform Administrator of citation. Next to the kitchen was an operational washer and dryer. LPA Tapia reviewed the COVID 19 mitigation plan and the Emergency Disaster Plan of the facility. LPA discussed Assembly Bill 665 that requires a licensee of any adult care residential facility that has internet service to provide at least one internet access device, such as a computer, smart phone, tablet or other device, that: can support real-time interactive applications; is equipped with video conferencing technology, including microphone and camera functions; and is dedicated for client or resident use. For this visit, One deficiency was noted in areas observed. One citation was issued. One advisory was issued today. LPA Tapia conducted an exit interview with Administrator Maria Pricilla Mirabueno and copy of this report was explained and left at the facility.