Routine inspection·June 17, 2024

On June 17, 2024 at 10:30am, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Administrator Maria Mirabueno and explained the purpose of the visit. The facility is licensed to operate for six (6) non-ambulatory and have a hospice waiver for six (6) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, two (2) bathrooms, living room, dining room, kitchen, attached 2-car garage, and an outside covered patio area. LPA Kim toured indoor and outdoor of the physical plant. There are no bodies of water or obstructions on the premises. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. All bedrooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Resident Room 4. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 111.2 degrees F and 111.5 degrees F. A comfortable temperature of degrees 77 degrees F was maintained in the facility. LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food, water, and supplies are stored in the garage. The facility has one (1) fire extinguisher that is charged and was serviced on September 1, 2023, and smoke detectors/carbon monoxide detectors were operable. The facility conducted Fire/Safety Drill on June 4, 2024 and does it quarterly. A working telephone (714-952-9242) remains available. First Aid Kit contained all the necessary elements. Evaluation Report Continues on LIC 809-C During the visit, LPs\A Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA conducted an audit of resident files (R1-R6), staff files (S1-S4), and medication and medication administration review. LPA Kim conducted resident interviews and staff interviews. A deficiency was cited during this inspection visit according to the California Code of Regulations (Title 22, Division 6, Chapter 8). An exit interview was conducted, and a copy of this report was provided to Administrator Maria Mirabueno.