Routine inspection·July 10, 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 Caregiver Herminiapaz Navarro. For today’s visit, LPA observed a total of six residents in care and two staff members on duty. LPA Ramirez toured the interior and exterior portions of the facility with Navarro. The facility is a two-story structure and is licensed for six non-ambulatory residents, of which six may be on hospice and zero bedridden. There are a total of eight bedrooms of which six are for residents and two for staff. LPA Ramirez 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 five restrooms of which four are for residents and one for staff. 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 107.7-116.8 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. LPA observed that the fire extinguisher was charged and mounted by the resident's bedroom hallway. During the visit LPA observed that the residents were having lasagna, fruit, juice, milk and/or water for lunch. CONTINUED ON LIC809-C.. LPA Ramirez observed the emergency disaster and evacuation plan, which is located by the staff office area. Facility had back-up emergency food and water supply. LPA observed that First Aid Kit had all the required components. LPA observed that medications were locked and inaccessible to residents in care. For the exterior portion, LPA Ramirez 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 three resident files and two staff files. LPA interviewed residents and staff present. For today's visit one deficiency was issued per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with facility representative. A copy of this report was provided at the time of exit