Routine inspection·November 7, 2024

On this day, Licensing Program Analysts (LPAs) Kevin Saborit-Guasch and Brandon Lopez made an unannounced visit to the facility for the purpose of conducting the required annual inspection. LPAs were greeted and granted entry by facility caregiving staff after introducing themselves and stating the purpose of the visit. Administrator Darryl Avendano and house manager Justin Cruz were notified of the visit via telephone and arrived later to assist. LPAs accompanied by facility staff conducted a tour of the physical plant and observed the following: the facility is a two-story home with an attached garage accessed from the side of the yard. The upper level is only for use by licensee and staff and is kept inaccessible to residents as verified during the visit. The second level consists of two rooms for use by male and female staff along with an additional bathroom used by staff. The facility has six private bedrooms and three shared bathrooms. All bathrooms are observed to be equipped with grab bars and slip mats. All resident bedrooms have the required furnishings. Bathrooms faucets and toilets are operational. Water temperature was measured at 113.5F and 114F in two bathrooms used for personal hygiene. LPAs observed all beds have linen and blankets. There are half rails used for postural supports in two of the bedrooms and full rails in a third. Physician orders for all three residents reviewed along with hospice plan of care. There are currently six residents admitted to the facility, four of which are receiving hospice care out of a waiver capacity of six possible hospice residents. LPAs observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. Drills are conducted quarterly, however only the most recent drill from September 2024 is observed to be documented. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke and carbon monoxide detectors tested operational. Fire extinguishers present are fully charged and have been maintained in 2024. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 There is adequately shaded outside space with outdoor furniture present. There are self-latching gates on each side of the property. The routes of egress are free of obstructions. Most cleaning products are observed to be secure throughout the physical plant, however three bottle of cleaning product and one bottle of bleach are observed to not be secured in the backyard. One type B citation provided on an attached LIC809-D form. The box used to store sharp items also does not lock anymore. Type A citation issued. The medication central storage was also observed to be secure and reviewed to be accurate and up to date with the resident's prescription orders with the exception of one medication for one resident which is not being logged for the month of November 2024. Type B citation issued. LPAs reviewed six resident files along with two staff files. Resident records include all necessary components. All staff members on the facility's roster are confirmed to be cleared and associated with this particular licensed location. Training and CPR training verified to be up to date. Health screenings are on file for both staff members. Based on the observations made during today’s inspection, three deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations and one Technical Violation Advisory Note issued. An exit interview was conducted and a copy of this report along with appeal rights was provided to a facility representative.