Routine inspection·April 9, 2025

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. At around 1:00 PM, LPA Tea was greeted and granted entry into the facility by caregiver staff and explained the reason for the visit. Administrator (AD) Gladys Ambion arrived shortly to assist with the visit. Facility is licensed for six non-ambulatory residents with a hospice waiver for six. Currently there are five residents, of which three are on hospice during today's visit. At 1:20 PM, LPA Tea reviewed five resident files and three staff files. Resident files and staff files contained all required documentation. Administrator certificate expires on July 19, 2025. LPA Tea along with AD Ambion toured the facility at 1:47 PM. LPA toured the physical plant, checked food service, and the first aid kit. The home consists of six resident bedrooms, staff room, six and a half bathrooms, living room, family room, dining room, office area, kitchen and an attached garage. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. 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 122.3 F degrees and 125.6 F degrees. The administrator did adjust the water temperature and signs were posted around the sinks to caution about the hot water. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, and doorways were free of obstructions. First aid kit had all the required elements including dressing, bandages, tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply were checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen drawer. LPA also observed toxin substances to be secured and locked and inaccessible to clients underneath the kitchen Annual inspection continued on LIC809-C sink and the garage. Fire extinguishers throughout the facility are fully charged. The facility’s last disaster drill was conducted in March 18, 2025. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample seating with shade and there are two exit gates on both sides of the house that are self-latching and operational. The backyard has a shaded patio area for clients to sit. There are various plants in the backyard garden, sometimes the residents come outside to enjoy the weather. LPA observed emergency supplies, food and water in the garage and kitchen. Activities are based on resident’s personal preference or health condition. Facility provides activities like karaoke and board games. At the time of the visit, LPA observed residents relaxing in their rooms. LPA then reviewed medication storage and administration. Medications are stored in a locked cabinet in the kitchen area. Medications are being administered per physician order. However, there was a minor error with evening medication given on the MAR record. LPA interviewed clients regarding their quality of care and spoke to staff present regarding care provided. Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the facility and a copy of this report LIC809, 809-C, LIC858, LIC859, LIC9102 was read and provided to the facility.