Routine inspection·February 9, 2024

On today's date, Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted an unannounced visit for the purpose of conducting a required Annual inspection. LPA was greeted and granted entry into the facility by Caregiver 1 (CG1). LPA Quiroz called Administrator (AD) Karmian Calangi and explained the nature of the visit. House Manager (HM) Roel Atanacio arrived during today's visit. This facility is licensed to provide services to age range 60 and over, approved for six (6) Non-Ambulatory Residents of which 1 (one) may be bedridden and has a hospice waiver for four (4) residents. There are (2) two residents receiving hospice services.(AD) Calangi has an Administrator Certificate with expiration date of 6/20/2025. LPA Rosie Quiroz along with (CG1) toured the interior and exterior of the facility. There are six (6) residents in care and there are no active COVID-19 cases in the facility at this time. During today's inspection tour, LPA Quiroz observed five of six residents in their bedroom resting and of one of six residents in the living room area watching television with staff supervision. LPA Quiroz interacted and interviewed with staff and residents during today's visit. Between 12:52pm-1:20pm while conducting inspection tour of kitchen, LPA Quiroz observed expired condiments and other food items, with expiration dates varying from 7/12/2023- 2/6/2024. This was verified with (CG1) (CG2) and (HM) Roel Atanacio. (See LIC 809-D) Between 1:30pm-1:40pm, while LPA Quiroz inspected resident's bedrooms and bathrooms. Water temperatures were recorded to be between 110.5-112.4 degrees Fahrenheit. LPA Quiroz inspected resident’s bedrooms and appeared to be clean. While inspecting Resident 6(R6s) bedroom area, LPA Quiroz observed medication in (R6s) bedroom area but not limited to Peptobismol, Zyrtec, Antacid tables, NyQuil and fluticasone nasal spray. This was verified with (CG1), (CG2) and (HM) Atanacio. (See LIC 809-D) Facility temperature in resident's bedrooms and throughout the facility was recorded to be within normal limits.CONTINUED ON NEXT PAGE... CONTINUED...LPA Quiroz observed the emergency and disaster and evacuation plan. Facility has a supply of emergency food, water and PPE in garage area and facility entrance readily available for staff and residents. LPA Quiroz toured the outside of the facility and observed seating and shaded area backyard for residents and visitor's enjoyment in backyard area. During today's visit, while LPA Quiroz provided Consultation on Title 22 and Infection control. Citation were issued during today’s visit. An exit interview was conducted with (HM) Roel Atanacio via telephone and with (CG1) at the facility. A copy of this report, LIC 811-Confidential names, LIC 809-D and Appeal Rights were provided to facility staff at exit.