Routine inspection·April 11, 2024

Licensing Program Analysts (LPAs) Celine De Perio and Faith La conducted an unannounced required annual inspection. LPA De Perio explained reason for visit and was greeted and granted entry by staff on duty and facility administrator (AD) Denis Dela Cruz. The PUB475 "See Something, Say Something" poster was observed to be at the entrance of the facility. LPAs observed the Administrator's Certificate for Denis Dela Cruz, which expired on 1/18/24, however provided proof to LPAs that a payment was made to obtain the renewed certificate and that certificate is pending. LPAs toured the interior and exterior portions of the facility with AD Dela Cruz. The facility is a two level structure and is licensed for 6 non-ambulatory residents, of which 0 may be bedridden and 4 may be on hospice. For this visit, there are a total of 4 residents in care, of which none are on hospice. On the first floor, there are a total of 3 shared resident rooms. On the second floor, there are 2 bedrooms, which are only designated for staff. LPAs verified that there are no residents residing on the second floor. LPAs toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. There are a total of 3 restrooms of which 2 are for residents on the first floor, and 1 is for staff on the second floor. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature in restrooms were measured to be at 107.0 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to residents in care, and located in a kitchen drawer. Fire extinguisher was charged, mounted and located in the kitchen. LPAs observed the emergency disaster and evacuation plan, which is posted at the entrance of the facility. Facility had back-up emergency food and water supply, located in the kitchen and in the garage. LPA De Perio observed that First Aid Kit had all the required components. Medications and toxins were observed to be locked and inaccessible to residents in care For the exterior portion, LPA De Perio observed patio furniture under shading, and the grounds were free of any hazards. There are 2 gates in the backyard, which were self-closing and self-latching. LPAs observed an empty pool in the backyard, that is locked by a gate, and is made inaccessible to residents in care. For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations. No citations were issued. An exit interview was conducted with AD Dela Cruz. A copy of this report was explained and provided.