Routine inspection·July 15, 2025

On July 15, 2025, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA Tirre was greeted by staff and granted entry after stating the purpose of the visit. Administrator (Ad) Lady Jean Veracruz was present to assist with the facility inspection on today's date. The facility is licensed for six (6) non-ambulatory residents of which one (1) may be bedridden with approved hospice waiver for five residents. Currently, there are three (3) Hospice residents present during today’s visit. This is a single story with detached garage facility. The facility has four bedrooms, ( three shared resident rooms and one staff room) and two full bathrooms. At around 11:30AM, LPA conducted a tour of the physical plant accompanied by Administrator Lady Jean Veracruz, and the following was observed: There are no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 113.1 degrees F. LPA observed the facility to be furnished at the time of the visit. Storage areas for cleaning supplies and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained. Facility has one fire extinguisher which was charged. A review of the Medication Records Administration (MAR) was conducted for three residents and LPA observed the records are in compliance. CONT ON 809C During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents. LPA observed the facility has a supply of Personal Protective Equipment (PPE). LPA observed First Aid Kit was maintained. A working phone was operational. The last fire drill was conducted on June 6, 2025. The facility had operational smoke and carbon monoxide in bedrooms and common areas. The facility has current liability insurance on file effective 6/20/2025 -6/20/2026. A review of five residents (R1-R5) service files revealed to be complete. The facility has the current administrator's certification on file for Lady Jean Veracruz # 6070564740 - Expiration 06/01/2026. Staff present during visit had proper background clearance. Based on the observations made during today's visit, a deficiency is being cited as per the Title 22 Division 6 Chapter 2 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights were provided to Administrator VeraCruz.