Routine inspection·January 23, 2025

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Administrator Cynthia Shoga was notified of the visit via telephone and arrived later to assist with the visit. There are currently five residents in care, two of which are receiving hospice care. LPA observed residents relaxing in their respective bedrooms and in the facility's common living areas. LPA accompanied by facility staff toured the physical plant. The facility is a one-story house. There are five privately occupied bedrooms, in addition to a room for use by overnight staff. There are four bathrooms throughout the facility. Bedrooms appeared clean and sanitary. Two bedrooms are equipped with full-length rails, however residents are confirmed to not be receiving hospice care at this time. Type B citation issued. LPA observed all the resident bedrooms have the required furnishings. Bathrooms appear clean and sanitary. Bathrooms are equipped with grab bars and slip mats. Hot water temperature measured within the required range in two separate bathrooms with faucets used for personal grooming. LPA observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items are stored in a secure drawer. Mounted fire extinguishers is charged. LPA tested the smoke and carbon monoxide detectors which were found to be operational. The centrally stored medication is located in a secure cabinet located in the dining area. Additional storage areas are inaccessible to residents. Cleaning supplies are stored securely in a secure storage locker accessible outside the house as well as under the kitchen sink. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 LPA and facility staff toured the outside of the facility. LPA observed an shaded outdoor seating areas with furniture for resident use. The perimeter gate on the side of the property is self-latching and can easily be opened in an evacuation. There are no bodies of water on the premises. LPA reviewed five resident records which included all necessary components. Two residents interviewed during the visit. LPA reviewed resident medication records and prescription orders with no discrepancies observed. There are no bedridden residents present on the premises. LPA reviewed three staff records. At the time of the visit, none of the two staff members present holds a current CPR training as both the administrator and the head caregiver had stepped away from the facility. Type B citation issued. All staff are background cleared and associated to the licensed location accurately. Based on the observations made during today’s visit, two type B deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report were provided to a facility representative.