Routine inspection·November 20, 2024

Licensing Program Analysts (LPAs) Kevin Saborit-Guasch and Brandon Lopez made an unannounced visit to conduct the required 1-year inspection. LPAs were greeted and granted entry by caregiving staff. Administrators Daryll Avendano and Mark Ryan Cruz were notified via telephone and later arrived to assist with the inspection. There are currently five (5) residents in care, one (1) of which is receiving hospice care. LPAs observed residents participating in activities in the facility’s common areas and relaxing in their respective bedrooms. At approximately 9:30am, LPAs accompanied by Administrator toured the physical plant. The facility is a one-story house with an attached garage. The facility has five (5) resident bedrooms, one (1) of which is shared, one (1) staff bedroom, and two (2) bathrooms which are shared. The four (4) individual and one (1) shared bedroom appeared clean and spacious. LPAs observed one (1) of the five (5) resident bedrooms had a gap between the glass sliding door. LPAs observed all the resident bedrooms has the required furnishings. Resident bathrooms appear clean and sanitary. Bathrooms were equipped with grab bars and non-slip mats. Hot water temperature measured between 106.9 and 107.2 degrees Fahrenheit. LPAs observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. LPAs observed knives locked in a lock box inside a locked kitchen cabinet. A fire extinguisher is located inside the kitchen which was observed to be charged and serviced as of April, 2024. LPAs tested the dual smoke/carbon monoxide detector which tested operational. The centrally stored medication is located in a locked closet next to the entrance door. The attached garage is inaccessible to residents and is used for storage and for laundry. Cleaning supplies are located in the garage. LPAs observed the facility has an emergency food and water supply which is also stored in the garage. CONTINUED ON FORM LIC809-C CONTINUED FROM LIC809 LPAs and administrator toured the outside of the facility and observed it to be free of obstructions. LPAs observed a shaded outdoor seating area with furniture for resident use. The perimeter gate on the southside of the facility is self-latching and can easily be opened in an evacuation. There are no bodies of water on the premises. LPAs reviewed five (5) of five (5) resident records. No discrepancies were observed. LPAs reviewed five (5) of five (5) resident medication records. No discrepancies were observed. LPAs interviewed two (2) residents. LPAs reviewed three (3) staff records. No discrepancies were observed. All staff are background cleared and associated to the facility. Based on the observations made during today’s visit, there is 1 type B deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. A Technical Advisory is also being provided regarding a resident’s admission agreement. This report was reviewed with facility Administrator and a copy of this report was provided. Appeal rights were provided to the Administrator.