Routine inspection·March 10, 2025

On March 10, 2025, Licensing Program Analyst (LPA) Eboni Bentley conducted an unannounced visit for the purpose of conducting an Annual Required-1 year inspection visit. LPA Bentley was greeted and granted entry by Caregiver (CG) Jovalyn Galang. Administrator (AD) Mark Cruz arrived shortly after and discussed purpose of the visit with LPA Bentley. AD Mark Cruz has an Administrator certificate pending renewal with a received date of November 22, 2024. The facility is licensed for age range 60 and over, approved for capacity of six (6) Non-Ambulatory residents, and has a hospice waiver for three (3) residents. There are currently six (6) residents present during today’s visit. The facility is a two-story house of which second story consists of: 4 bedrooms, and 3 bathrooms which are utilized for caregivers. 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. LPA Bentley toured the interior and exterior of facility with AD Cruz. and the following was observed: There were no bodies of water on the premises, all rooms were inspected, beds and bedding supplies were available, lighting was provided in all rooms, and storage for the residents’ personal belongings were observed in residents’ closets. Additional bed linens, comforters, and bath towels were available during the visit. The water temperature in 3 of 3 resident bathrooms were measured to be between 101.2 and 129.5 degrees Fahrenheit. This poses an immediate risk to residents in care. (SEE LIC 809-D) Grab bars and non-slip mats were observed in all resident bathrooms. The kitchen was clean and organized. All knives and sharp objects were locked in a drawer near the stove. A two-day supply of perishable food items and seven-day supply of nonperishable food items was observed. CONTINUE TO LIC-C PAGE.... LPA observed three fire extinguishers mounted and charged in garage, kitchen, and hallway area, which were last serviced on March 5, 2025. LPA observed and tested carbon monoxide and smoke alarms which all operational. A record review reveals fire drills are being conducted quarterly with the last drill on January 25, 2025. The attached 2-car garage was observed clean and walkways were free of clutter and debris. A washer and dryer were found in working condition. LPA Bentley observed an adequate amount of emergency food and water supply. The backyard was clean and free of clutter and debris. The exit gate on the exterior of the home was self-closing and self-latching, and in operating condition. LPA conducted a review of six residents (R1-R6) service files and five (5) staff (S1-S5) personnel files revealed to be complete. Facility has liability insurance on file effective May 15, 2024 through May 15, 2025. A review of the Medication Records Administration (MAR) was conducted and found to be within Title 22 California Code of Regulations. LPA Bentley interacted with and interviewed 6 of 6 residents during facility tour. 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 and Appeal Rights were provided at exit.