Routine inspection·October 23, 2024

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit for the Required 1 Year Inspection. LPA explained the purpose of today’s visit, and was greeted and granted entry by Administrator (AD) Eric Gilbert. For today’s visit, LPA observed a total of five residents in care and two staff members on duty. During today's visit LPA observed the AD certificate for AD Suzanne Anderson which expires on February 17, 2026. LPA toured the interior and exterior portions of the facility with AD Gilbert. The facility is a two-story structure and is licensed for one ambulatory and five non-ambulatory residents, of which six may be on hospice and one bedridden. There are a total of nine bedrooms, of which six are resident bedrooms, and three are bedrooms for staff. LPA toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. There are a total of four restrooms. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature tested between 108.3-110.7 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to residents in care. Fire extinguishers were charged and one was located by the kitchen and one by the Residents' bedroom hallway. During today's visit LPA observed as residents were watching television and having lunch. LPA observed the emergency disaster and evacuation plan which is located by dining room. Facility had back-up emergency food and water supply. CONTINUED ON LIC809-C... LPA observed that First Aid Kit had all the required components. LPA observed that medications and toxins were locked and inaccessible to residents in care. For the exterior portion, LPA observed a shaded area, patio furniture, and the grounds were free of any hazards. There are two gates in the backyard, which both are self-closing and self-latching. No bodies of water were observed. LPA reviewed five resident and two staff files. LPA interviewed residents and staff present. During today's visit LPA consulted with AD regarding the updated Health Screening Report-Facility Personnel (LIC503). LPA informed AD to use the updated LIC503. For today's visit one deficiency was issued per Title 22 Division 6 of the California Code of Regulations. LPA advised AD Gilbert to use the general email address: CCLASCPOrangeCountyRO@dss.ca.gov for any inquiries and to specify attention to the assigned LPA. An exit interview was conducted with AD Gilbert. A copy of this report and Appeal Rights were provided at the time of exit.