Routine inspection·June 13, 2024

Licensing Program Analysts (LPA) Jerome Haley conducted an unannounced visit to the facility to complete the required Annual inspection. LPA Haley met with Licensee/Administrator Raymond Tinio and toured the facility. The facility has a capacity of 6, of which 6 can be non-ambulatory and 1 may be bedridden. The facility has a Hospice waiver for 6. The facility telephone number 714.723.0169. Structure : The facility is one level structure with four bedrooms. Currently one bedroom is vacant and one bedroom is being shared by a husband and wife. Kitchen: Clean and organized. Sharps locked in a drawer. A perishable food supply was observed in the refrigerator and freezer. Non-perishable food supply was observed in the cabinets. Stove/Appliances: There’s one stove with 4 burners and a warmer, a refrigerator, dishwasher, washer, and dryer. All appliances are clean and operational. Toxins: All cleaning supplies and chemicals are locked under the kitchen sink. Medications, First-Aid Kit: Resident medications are stored in a locked cabinet in the kitchen. There’s a first aid kit with all the required elements on a stand right below the sign in book as soon as you walk in the front door. Resident & Staff Files : The Resident and Staff Records are kept locked in a desk drawer in the office area in between the living room and kitchen areas. Bedrooms: Resident bedrooms were clean, organized and were in compliance with regulation guidelines. Bathrooms: There are two bathrooms and both bathrooms have a working toilets, wash basin and shower. Grab bars were tightly secured to the wall. Hot Water : Hot water was measured in the range of 105 - 107.1 degrees F. Continued on LIC809C Hygiene Supplies : The facility has an adequate supply of hygiene items on hand. Linens, Hygiene, Emergency Supplies: Additional linens for each resident are stored in a closet right next to the front door. Emergency Evacuation Drills: The most recent evacuation drill was conducted April 12, 2024, and are conducted quarterly for all staff. Medication Review: There are currently four residents in the facility and medication was reviewed for 2 of 4 residents. Resident File Review: A file review was completed for all four residents. Staff File Review: 4 staff files were reviewed during the visit. Garage: The garage is used to store facility items. Walkways are free of obstruction. A washer and dryer was observed. Some of the items being stored in the garage are walkers, wheelchairs, N95 mask, and a few old mattresses. Backyard: Clean, organized and walkways are free of obstruction. There are two tables with chairs under a shaded patio. Side exit gates are self-closing and self-latching. Smoke Detectors/Carbon Monoxide Detectors: Smoke detectors and the carbon monoxide detector tested operational. There’s a fully charged fire extinguisher mounted on the wall in the office area. Misc (P&I): N/A. The facility does not manage any of the resident’s money. Activities, Recreation, Reading Material, etc: Exercises and ball toss are the primary activities. There is a bingo game and the facility celebrates resident birthdays. Citation(s) & TV/TA: No citations of technical violations will be issued as a result of todays inspection. Exit Interview: Exit interview was conducted, and a copy of this report were provided to Licensee/Administrator Raymond Tinio and Administrator Macrina Jabonero.