Routine inspection·May 16, 2025

On May 16, 2025, at 8:00am, Licensing Program Analyst (LPA) Eboni Bentley arrived at the facility unannounced for the purpose of conducting a Required-1 year inspection using the CARE Inspection Tool. LPA Bentley was greeted and granted entry by Caregiver (CG) Anna Tangonan and explained the purpose of today's visit. Administrator (AD) Mark Cruz arrived shortly after and was present throughout the inspection. AD Mark Cruz has an Administrator certificate with an expiration date of December 2, 2026. The facility is licensed for age range 60 and over, approved for capacity of six (6) non-ambulatory residents, of which one (1) may be bedridden, and has a hospice waiver for six (6) residents. There are currently four (4) residents on census and all were present during today’s visit. The facility is a one story house that consists of: five resident bedrooms, one staff bedroom, two bathrooms, living room, dining area, and kitchen. There is a sun room in the back of the facility, next to dining area, used as an activity room and family visitation area. LPA toured the interior and exterior of facility with AD Cruz, and the following was observed: There were no bodies of water on the premises, all rooms were inspected and observed with all required elements, lighting provided, and storage for the residents’ personal belongings. Additional bed linens, comforters, and bath towels were available during the visit. Both bathrooms have secure grab bars and non-slip mats. The water temperatures in both bathrooms were initially measured between 103.6 and 105.9 degrees Fahrenheit. Adjustments were made and when tested a second time, water temperatures measured between 110.6 and 113.5 degrees Fahrenheit. A technical assistance advisory note is being issued and AD agreed to monitor water temperatures to ensure they are maintained at the correct levels. Continue to LIC 809-C The kitchen was clean and organized. All knives and sharp objects were locked in a drawer near the sink. Toxins were locked and stored in cabinet. A two-day supply of perishable food items and seven-day supply of nonperishable food items observed. Room temperature inside the facility was recorded to be 73 degrees Fahrenheit. LPA observed one (1) fire extinguisher, mounted and charged in the kitchen area, and last serviced on March 5, 2025. The carbon monoxide and smoke alarms were tested and observed to be functional and operational. A record review revealed disaster and fire drills are conducted quarterly with the last drill done on April 18, 2025. LPA observed a first aid kit with all the required elements. Facility has liability insurance on file effective May 15, 2025 through May 15, 2026. The attached 2-car garage was observed clean, and walkways were free of clutter and debris. A washer and dryer were found in working condition. LPA observed an adequate amount of emergency food and water supply. The backyard was clean and free of debris. LPA observed a shaded area, with a table and available seating. There were two exit gates on each side of the exterior of the home. Both self-closing and in operating condition. LPA conducted a review of four (4) residents (R1-R4) service files and four (4) staff (S1-S4) personnel files. All were observed complete. A review of the Medication Records Administration (MAR) and medication was conducted and found to be within compliance. LPA observed and interviewed residents and staff during the visit. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with (AD) Mark Cruz, a copy of this report and one technical assistance - advisory note provided.