Routine inspection·April 15, 2024

On today's date, Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted an unannounced visit for the purpose of conducting an Annual Required-1 year inspection visit. LPA was greeted by Caregiver 1. Administrator (AD) Mark Cruz arrived shortly after and discussed purpose of the visit. AD Mark Cruz has an Administrator certificate with expiration date of 12/2/2024. The facility is a two-story house of which second story consists of: 4 bedrooms, and 3 bathrooms which is utilized for caregivers and Administrator headquarters. The first floor consists of: 4 resident bedrooms; of which 2 bedrooms are shared bedrooms and 2 are private bedrooms, 3 bathrooms for staff and residents, living room, dining area, and kitchen. There is a sun-room in the back of the facility next to dining area used as an activity room and for family visitations. There is an attached 2 car garage with an operational washer and dryer. The backyard has a shaded concrete area for resident and visitor enjoyment. The exit gates on the exterior of the home are locked from the outside have self-closing and self-latching mechanisms in operating condition. The facility is licensed for age range 60 and over, approved for capacity of 6 (six) Non-Ambulatory residents, and has a hospice waiver for (6) six residents. There are currently (4) four residents currently receiving hospice care services. LPA along with CG1 toured the interior and exterior of facility. LPA observed kitchen for proper sanitation and cleanliness. LPA observed Sharp objects locked and secured in cabinet in kitchen area, and observed toxin substances to be locked and inaccessible to residents in care in locked and secured closet in garage area. The food was observed to meet the minimum requirement of two days perishable and seven days nonperishable food supply for residents in care. CONTINUED ON LIC 809-C PAGE... CONTINUED...Six of six resident bedrooms were observed to have required furnishings including but not limited to: lamp, bed, mattress, night stand and clean linen. LPA Quiroz interacted and interviewed 3 of 6 residents during facility tour. LPA Quiroz not able to qualify and interview 3 of 6 residents in care. The water temperature in 3 of 3 resident bathrooms were measured to be between 114.7-116.6 degrees Fahrenheit. The Grab bars and non-slip mats were observed in resident bathrooms. Room temperature inside the facility was recorded to be 74 degrees F. During today’s visit, LPA Quiroz observed temperature gage box to be locked and secured. (SEE LIC 9102-TV) The outside grounds were inspected during facility tour, and no bodies of water were observed. No pool available at this facility. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. LPA observed three fire extinguishers mounted and charged in garage and hallway area, which were last serviced on 3/05/2024. LPA observed and tested functional and operational carbon monoxide and smoke alarms. (AD) Mark Cruz reports fire drills are conducted quarterly with staff and residents. Last facility fire drill was conducted on March 22,2024. CG1 reported offering the following indoor and outdoor activities at the facility according to weather conditions: "walks, painting, ball and arm range of motion exercises." LPA Quiroz reviewed whether the facility is operating within capacity limitations and reviewed repeated violations, no repeated violations assessed. During today's visit, LPAs reviewed six of six resident records and four of four personnel files. Resident and personnel files were found to be within Title 22 California Code of Regulations. At 3:23pm, LPA Quiroz reviewed centrally stored medications for 6 of 6 residents. During centrally stored medication review, LPA Quiroz observed 4 of 6 resident’s centrally stored Comfort KIT medications consisting of: Acetaminophen, Morphine, Lorazepam, Bisacodyl, Hyoscyamine, Ondansetron and Albuterol in refrigerator in kitchen which is unlocked and unsecured. This poses an immediate risk to residents in care. (SEE LIC 809-D) During today's visit, LPA Quiroz provided Consultation on Title 22, COVID-19 Mitigation and Infection control throughout today's visit. Based on the observations made during today’s visit; the facility is being cited per Title 22 Division 6 of the California Code of Regulations. This report was read and reviewed with (AD) Mark Cruz, and a copy of this report, LIC 858, LIC 859, LIC 809-D, LI 9102-TV and Appeal Rights were provided at exit.