Routine inspection·November 21, 2024

Licensing Program Analysts (LPAs) Alvaro Ramirez, Jr. and Brandon Lopez conducted an unannounced visit for the Required 1 Year Inspection. LPAs explained the purpose of today’s visit, and were greeted and granted entry by Caregiver Juanita Marvin. Administrator (AD) Brevet Dao was notified via telephone by staff. AD arrived at approximately 3:45 pm. For today’s visit, LPAs observed a total of three residents in care and one staff member on duty. LPAs observed the Administrator Certificate for Administrator Assistant Ladyjean Veracruz which expires on June 01, 2026. LPAs toured the interior and exterior portions of the facility with caregiver Marvin. The facility is a single level structure and is licensed for six non-ambulatory residents of which five may be on hospice and two bedridden. There are a total of four bedrooms, of which three are resident bedrooms, and one private bedroom for staff. During the tour LPAs observe the 20"x26" complaint poster (PUB 475) located by the entryway. LPAs toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. There are a total of two restrooms. Restrooms were observed to be in good repair, toilets were operational, and grab bars were provided. LPAs observed that two of two restrooms do not have non-skid floor mats; a Deficiency was issued. Water temperature tested between 106.3-110.6 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were observed to be unlocked in a kitchen drawer; a Deficiency was issued. Fire extinguisher was charged and located by the kitchen. Fire extinguisher was last service on June 18, 2024. CONTINUED ON LIC809-C... LPAs observed the emergency disaster and evacuation plan which is located by the entryway. Facility had back-up emergency food and water. LPAs observed that the First Aid Kit had all the required components. LPAs observed that medications were locked and inaccessible to residents in care. During the tour LPAs observed a Comex bleach powder cleaner and a liquid bleach cleaner on the first restroom, next to the living room; a Deficiency was issued. Chemicals were observed to be unlocked. For the exterior portion, LPAs observed a shaded area, patio furniture, and the grounds were free of any hazards. There is one gate in the backyard, which both is self-closing and self-latching. No bodies of water were observed. LPAs reviewed three resident files and two staff files. LPAs reviewed the Medication Administrator Record (MAR) for Resident 1 (R1). Per preplacement appraisal dated 10/21/23 under Services Needed it states that Resident 1 (R1) needs help with medication. LPAs observed that PM Buspirone 5mg and PRN Hydrocodone-Acetamin were out of pills; a For today's visit deficiencies were issued per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Ladyjean Veracruz. A copy of this report and Appeal Rights were provided at the time of exit.