Routine inspection·January 24, 2025

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPA Tea was greeted and granted entry into the facility by caregiver Marilou Escalona. Lead caregiver staff Liezl Parajuli arrived shortly to assist with the visit and explained the reason for the visit. Administrator Rhoena Fajardo is on vacation. Facility is licensed for 6 non-ambulatory residents, with a hospice waiver for four. Currently there are five residents, of which four are on hospice during today's visit. At around 11:30, LPA Tea reviewed five resident files and two staff files. There were discrepancies noted in the review of staff files. Administrator certificate expires on April 10, 2026. There are no records of required quarterly disaster drills. LPA Tea along with caregiver toured the facility around 12:06 PM. LPA toured the physical plant, checked food service, and the first aid kit. The facility is a two-story home that consists of 3 resident bedrooms, 2 bathrooms, living room, dining area, kitchen, sunroom and attached garage. The second story is staff only area where residents do not reside at. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms, and they are operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 107.6 degrees F and 106.8 degrees F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including bandages, dressings, tweezers, thermometer, and scissors. Kitchen was inspected. Kitchen appliances are operational during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen drawer. LPA also observed toxin substances to be locked and inaccessible to clients in care under the kitchen sink and in the garage. The fire extinguisher in the kitchen is fully charged. LPA toured the outside grounds and there is ample seating with shade and the exit Continuation of annual inspection on LIC809C gate on the right side of the facility is self-latching and operational. LPA observed emergency supplies, food and water supply in the garage. Facility provides activities based on resident interests. The residents play card games and bingo, they paint and go outside sometimes. At the time of annual visit, residents were watching television and eating lunch. LPA reviewed medication storage and administration. Medications are stored in a locked cabinet. Medications are being administered per physician order but not properly documented. LPAs interviewed residents regarding their quality of care and spoke to staff present regarding care provided. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with facility staff and a copy of these reports were given to the facility along with a copy of the LIC 858; 859;809-D, 9102 and Appeal Rights.