Routine inspection·December 3, 2024

On December 3, 2024, at 1:45pm, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and granted entry by staff. LPA Kim met with Administrator (AD) Maria Pricilla Mirabueno and explained the purpose of the visit. The facility is licensed to operate for six (6) nonambulatory residents and have a hospice waiver for six (6) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, caregiver bedroom, two (2) bathrooms, living area, dining area, kitchen, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with Caregiver Lanie Pangilinan. There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Resident Room 4. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 115.7 degrees F to 117.3 degrees F. A comfortable temperature of 76 degrees F was maintained in the facility. LPA Kim observed the facility to be sanitary at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food is stored in the kitchen and in the garage, and emergency water and emergency supplies were stored in the garage. The facility has one (1) fire extinguisher that was charged, mounted in the kitchen, and inspected on September 6, 2024. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. A working telephone (714-332-0130) remains available. LPA Kim conducted an audit of resident files (R1-R6). Due to time constraint a continuation of this inspection will be conducted at a later date. LPA will conduct record review of staff files, medication review, first aid kit, video teleconferencing device, smoke detector and carbon monoxide detector check, staff interviews, and resident interviews. A deficiency was cited during this visit as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights were provided to Administrator Maria Pricilla Mirabueno.