Routine inspection·October 10, 2024

On this day, Licensing Program Analysts (LPAs) Kevin Saborit-Guasch and Samer Haddadin made an unannounced visit to the facility for the purpose of conducting the required annual inspection. LPAs were greeted and granted entry by administrator Troy Ujimori after introducing themselves and stating the purpose of the visit. LPAs accompanied by administrator conducted a tour of the physical plant and observed the following: the facility is a two-story home with an attached two-car garage. The house's second floor is accessible only through the garage and a locked door with a digital code on the handle and is only for use by facility staff. The first level has five bedrooms including a master bedroom which can be shared and four private bedrooms, in addition to a bedroom used by staff overnight. There are two bathrooms including the en-suite bath of the master bedroom. 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, however due to a plumbing intervention occurring due to a leak inside one of the bathrooms, the water temperature could not be measured during the present visit. An annual continuation visit will therefore be required. LPAs observed all beds have linen and blankets. There are currently four residents admitted to the facility, none of which are receiving hospice care. LPAs observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. Drills are conducted quarterly but are not documented by staff and licensee as required by regulations. Consultation provided. LPAs 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 extinguisher present is fully charged and has been maintained in 2024. 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. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 Medication, cleaning products and sharp items are confirmed to be inaccessible throughout the physical plant. 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. LPAs reviewed four 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. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Three consultations provided. An exit interview was conducted and a copy of this report was provided to a facility representative.