Routine inspection·April 2, 2024

On today's date, Licensing Program Analysts (LPAs) LPA Rosie Quiroz and LPA Michael Tea conducted an unannounced visit for the purpose of conducting a required Annual inspection. LPAs were greeted and granted entry into the facility by Caregiver 1 (CG1). LPAs met with Licensee/Administrator (L/AD) Rhoena Fajardo and discussed purpose of today's visit. This is a a Residential Care Facility for the Elderly, licensed to provide services to age range 60 and over, approved for capacity of (6) six Non-Ambulatory residents and has a Hospice waiver approved for 4 hospice residents. There are currently four (4) residents in care at this time, of which (1) one is receiving hospice care services. There are no active COVID-19 cases in the facility at this time. AD Rhoena Fajardo has an Administrator certificate with expiration date of April 10, 2024. AD Rhoena Fajardo indicated currently in process of renewing Administrator certificate, and agreed to submit copy of renewal to Community Care Licensing upon completion. LPAs along with (AD) Fajardo toured the interior and exterior of the facility. During today's inspection tour, LPAs observed 3 of 4 Residents in the living room with staff supervision and 1 of 4 residents in their bedroom. LPA Quiroz interacted and interviewed with Caregiver and 4 of 4 residents during today's visit. LPAs nspected resident's bedrooms and bathrooms. The water temperature in resident's bathrooms were recorded to be between 105.3 and 105.4 degrees Fahrenheit. LPAs inspected resident's bedrooms and appeared to be clean. Facility temperature in resident's bedrooms and throughout the facility was recorded to be within normal limits. LPAs observed the emergency and disaster and evacuation plan. Facility has supply of emergency food, water and PPE in the garage area readily available for staff and residents in care. Fire extinguisher observed last serviced on November 14, 2023. LPAs observed functional and operational washer and dryer in the garage area. Medications, sharps and disinfectants were observed to be locked and secured. LPAs toured the outside of the facility and observed seating and shaded area in the backyard for residents and visitor's enjoyment. (SEE LIC 9102-TV) LPAs reviewed 4 of 4 resident records and 4 of 4 personnel files. CONTINUED ON LIC 809-C PAGE... CONTINUED... While conducting resident records review for Resident 1 (R1), LPAs observed LIC 602- Physician report for Resident 1 dated 11/22/2022. (SEE LIC 809-D). While reviewing centrally stored medications for Resident 4, LPAs observed two medications and 2 supplement medications not listed on Medication Administration Records. This was verified with L/AD Fajardo (SEE LIC 809-D) Citations and Technical Violations issued during today's visit. During today's visit, LPAs provided Consultation on Title 22 and Infection control. An exit interview was conducted with (L/AD) Rhoena Fajardo, and a copy of this report, LIC 809-D pages, LIC 9102 Technical Violation, Appeal Rights, LIC 858- Client/Resident's records review and LIC 859- Staff Records Review were provided at exit.