Routine inspection·June 4, 2024

On June 4, 2024 at 8:50AM, 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 House Manager (HM) Bryan Bernardino and explained the purpose of the visit. The facility is licensed to operate for six (6) non-ambulatory of which one (1) may be bedridden 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: six (6) resident bedrooms, six (6) bathrooms, living room, dining room, kitchen, and outside covered patio area. LPA Kim toured indoor and outdoor of the physical plant with AD There are no bodies of water or obstructions on the premises. All rooms were inspected. 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 3, Resident Room 4, Resident Room 5, and Resident Room 6. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 112.7 and 115.1 degrees F. A comfortable temperature of 74 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 supplies and emergency food are stored in the medication closet. The emergency water is stored in the garage. The facility has one (1) fire extinguisher that is charged and was serviced on October 20, 2023, smoke detectors, and carbon monoxide were operable. A working telephone (949-215-2128) remains available. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and clients, and sanitizing stations in common area. 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 three (3) resident files and six (6) staff files. LPA Kim conducted an audit on resident medication and medication administration review. LPA Kim conducted two (2) staff interviews. Deficiencies were 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 House Manager Bryan Bernardino.