Routine inspection·April 4, 2025

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by Administrator Mary Joy Garcia and explained the reason for the visit. Facility is licensed for 6 residents of which 5 may be non-ambulatory and 1 may be bedridden. Facility has an approved hospice waiver for 6 residents and the home currently has 5 residents, with 1 resident on hospice. Administrator has a valid certificate that expires on 1/25/2027. AD provided updated liability insurance that expires on 5/15/2025. LPA along with AD toured the facility at 1:15 PM. LPA toured the physical plant, checked food service, facility documentation and the first aid kit. The home consists of 4 resident bedrooms, staff bedroom, living room, dining room, and kitchen as well as 2 resident bathrooms. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 105.8 degrees F and 107.9 degrees F in all restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Auditory exit alarms were operational during today's visit. LPA toured the kitchen and observed sharps locked in a cabinet during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. Outside grounds were toured. Walkways around the home were clear of hazards. There is shaded outdoor seating for residents. Continued on LIC809C dated 4/4/2025 Exit gate is unlocked and operational. There are no security bars or weapons on the premises. First aid kit contained all required items including tweezers, scissors and thermometer. Facility conducts activities in the form of exercise. LPA observed the emergency food and water supply. LPA reviewed five resident files and two staff files. All resident files contained required documentation including admission agreements, physician reports, and resident appraisals. Staff files reviewed contained documentation including medical assessment/ TB, criminal record clearance and proof of CPR training. At 2:50pm, LPA observed 1 out of 2 staff files missing continuous annual training documents. LPA reviewed medication storage and administration. Medications are stored in a locked closet. Based on the observations made during today’s visit, a deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided along with appeal rights.