Routine inspection·February 12, 2025

Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by caregiving staff after explaining the purpose for the visit. Administrator (AD) Mark Mendez was notified via telephone and later arrived to assist with the inspection. LPA observed that Administrator Mark Mendez submitted a Administrator renewal application to the Administrator Certification Bureau (ACB) on February 2, 2025. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six ambulatory, of which five may be non-ambulatory and one may be bedridden, and has a hospice waiver for six. The facility is a single-story home with five resident bedrooms, one of which is shared, three resident bathrooms, one of which is shared, a living room, a dining room, a kitchen, and an attached two car garage. LPA accompanied by the AD conducted a tour of the interior portion of the facility. On today's visit, LPA observed six residents in care, two of which are on hospice, and two caregiving staff present. LPA observed residents relaxing in the living room as well as their respective bedrooms. LPA observed the See Something, Say Something poster (PUB 475) mounted on a wall by the kitchen. LPA inspected the five resident bedrooms, and they were observed to be free of any hazards. LPA observed a fireplace in resident room #1. LPA observed that the fireplace is adequately screened and not in operation at the time of visit. LPA observed the resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. All resident beds had clean linens and blankets. LPA observed additional linens are stored in a hallway closet. LPA inspected the three resident bathrooms. Resident bathrooms are clean. Bathrooms are equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 106.7 and 112.4 degrees Fahrenheit. LPA observed the kitchen has a two day perishable and seven day nonperishable food supply on hand. LPA observed two medications to be stored in the refrigerator. LPA observed kitchen appliances to be clean and operational. The four burner gas stove lights unassisted. CONTINUED ON LIC809-C LPA observed kitchen knives are stored in a locked kitchen cabinet. LPA observed the facility has a three day emergency food and water supply stored in the kitchen. A fire extinguisher is located in the kitchen, and it was observed the be charged and up to date on service. LPA tested the wired smoke detectors/carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on February 3, 2025. The centrally stored medication is kept in a locked medicine cart located in a locked closet by the living room. LPA observed a First Aid kit is stored in the closet and it was observed to have all the required components. The door leading to the attached two car garage is kept locked and inaccessible to resident in care. LPA observed the garage is used for storage and laundry. LPA and AD conducted a tour of the exterior portion of the facility. LPA observed the exterior portion to be clear of obstructions and hazards. LPA observed a shaded outdoor seating area with furniture for resident use. The perimeter gate on the north side is self-latching and can be opened in an evacuation. There are no bodies of water on the premises. LPA reviewed the six resident files. All the required documentation were present and current in the resident files reviewed. LPA reviewed six residents’ medication and medication records. LPA reviewed four staff files. LPA observed that Staff #4 (S4) did not have a Health Screening Report on file. All staff are background cleared and associated to the facility. Based on today's observations, deficiencies being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Administrator Mark Mendez. A copy of the report and Appeal Rights were provided.