Routine inspection·April 7, 2025

On April 7, 2025, at 12:15 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) Yolinda Demate. Administrator (AD) Maricel Nepomuceno stated over the phone they could not make today's visit and LPA Kim explained the purpose of the visit. AD Nepomuceno stated that CG Kristyn Carteciano could sign the report in behalf of the facility. The facility is licensed to operate for six (6) nonambulatory residents, of 1 which may be bedridden, 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: five (5) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, living area, dining area, kitchen, outdoor covered patio, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with CG Carteciano. There were no bodies of water or 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, and Resident Room 5. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 109.5 degrees F. A comfortable temperature of 74 degrees maintained in the facility. Evaluation Report Continues on LIC 809-C 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. 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. 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. Emergency food, emergency water, and emergency supplies are stored in the garage. A working telephone (714-646-9615) and an internet accessible device dedicated to the residents that can do video teleconference which both remain available. Last emergency drill was conducted on January 13, 2025. First aid kit is maintained and contains all the necessary elements. Evidence of liability insurance is effective February 6, 2025, and expires on February 6, 2026. LPA Kim conducted an audit of resident files (R1-R4), staff files (S1-S6), and medication and medication administration record that were all in order and complete. LPA Kim conducted two (2) staff interviews and two (2) resident interviews. No deficiencies were cited during this inspection visit. An exit interview was conducted, and a copy of this report was provided to Caregiver Kristyn Carteciano.