Routine inspection·May 14, 2025

On May 14, 2025, at 1:45 PM, 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 was greeted and granted entry by Caregiver (CG) Cinthya Gomez. Administrator (AD) Daniel Datcu arrived at the facility around 2:25 PM and LPA Kim explained the purpose of the visit. The facility is licensed to operate for six (6) nonambulatory residents, and has a hospice waiver for four (4) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: six (6) resident bedrooms, one (1) staff bedroom, four (4) bathrooms, living area, dining area, kitchen, fountain in the backyard, shed in the backyard, outdoor covered patio in the backyard, front patio has two chairs and table, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with ADMIN Datcu. There were no obstructions in the facility. 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. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 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 113.1 degrees F to 115.0 degrees F. A comfortable temperature of 76 degrees F was maintained in the facility. Evaluation Report Continues on LIC 809-C LPA Kim observed the facility to be 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 both were available and maintained properly. Emergency food, emergency water, and emergency supplies are stored in the garage. The facility has one (1) fire extinguisher that is charged and mounted on the wall next to the dining room and was last inspected on July 18, 2024. During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. PUB475 measured at 11”x17” instead of 20”x26”. The smoke detectors and carbon monoxide detectors were operable. A working telephone (714-756-2341) and video teleconferencing laptop dedicated to the residents both remain available. Last emergency drill was conducted on May 5, 2025 and is conducted monthly.. First aid kit is maintained and contains all the necessary elements. Evidence of Liability Insurance is effective March 21, 2025, and expires March 21, 2026. LPA Kim conducted an audit of resident files (R1-R6), staff files (S1-S7), and medication and medication administration record. LPA Kim conducted two (2) resident interviews. No deficiencies were cited during this visit per Title 22 Division 6 Chapter 8. A technical violation was issued during the visit in regards to PUB475 measuring at 11” x 17”. An exit interview was conducted, and a copy of this report and was provided to Administrator Daniel Datcu.