Routine inspection·March 25, 2025

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Bonifacio Briones, House Manager at 1pm. The facility is a single story residence with three resident bedrooms and one staff bedroom. The facility has an approved fire clearance of five non-ambulatory residents of which one may be bedridden and a hospice waiver for six. The facility currently has a census of six residents in care. During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in two of two resident bathrooms, and testing auditory devices on all exits . The hot water temperature measured between 117.8 and 127.0 degrees Fahrenheit and a Type A deficiency will be cited. House Manager was advised to lower water heater temperature and to secure cleaning products in the main bathroom cabinet. All smoke detectors were operational . The fire extinguisher is charged and was serviced on September 13, 2023. The facility did not have a fire drill on file . LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. The weekly menu was posted on refrigerator. LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. The First Aid kit has all the required elements but did not have a First Aid book. (Continued on LIC 809-C) (Continued from LIC 809) LPA toured the exterior of the facility and observed a shaded seating area and ample room for outdoor activities. There are no hazards or obstacles in exterior passageways. All storage units were locked. LPA reviewed three of three staff training and fingerprint records and conducted a complete review of resident records. LPA requested to see bedrail orders for five of six residents but none were on file in physician's orders or hospice orders. Three of six resident records did not have a medical assessment or appraisal needs and services plan. A sixth resident recently moved in within a week and only had a hospice file. Type B deficiencies will be given regarding documentation. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on March 17, 2026. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Bonifacio Briones, House Manager and a copy of this report was given to the facility along with a copy of the LIC 858, LIC 859; LIC 809-D and Appeal Rights.