Routine inspection·April 23, 2025

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose of conducting the Required 1-Year annual evaluation using the Care Inspection Tool. LPA was greeted and granted entry by Caregiver Lian Tjia and explained the reason for the visit. Administrator (Admin) Anthony Coloma arrived on premise to assist with the inspection. Admin Anthony holds a valid certificate expiring on November 25, 2025 and October 24, 2025 for Administrator Maureen Salonga. The facility is a single story structure and is licensed to provide services for age range 60 and over for six non-ambulatory, of which one may be bedridden in bedroom #1. Facility can provide hospice services to six residents at one time. During today's visit, there are two out of six residents under hospice care and three caregivers on duty. LPA toured the physical plant with Admin Anthony and Lead Staff Marianne Salonga. LPA observed five resident bedrooms and three resident bathrooms. Resident bedrooms had all required furnishings. Bathrooms were found to be in compliance, clean, and operational. The hot water temperature measured at 109.0, 108.3, and 108.1 degrees Fahrenheit. All common areas were inspected including the attached two car garage. LPA observed sufficient emergency food and water. Disaster supplies indicated on the Emergency Disaster Plan (LIC610E) were not maintained. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food available in the kitchen and garage. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction. Both exit gates were self-closing and self-latching. LPA observed sufficient seating and shading. The fire extinguisher was mounted and serviced in March 2025. The auditory devices and smoke/carbon monoxide detectors were tested and operational. Emergency evacuation drills are conducted quarterly. Last known drill was conducted on February 3, 2025. The facility land line number, (949) 446-6898, was tested and remains available. The Complaint Poster, 'See Something, Say Something,' (PUB 475) was available and posted in the correct size. LPA conducted a file review of all residents and two staff files. A discrepancy was noted as the Physician's Report (LIC602) for Resident #1 (R1) was not updated. There were no concerns with staff files. Medications were audited, and interviews were conducted during today's visit. The following items were addressed during the exit interview: to acquire emergency supplies as documented on the LIC610E and to ensure the LIC602s are updated as needed. Based on the observations made during today's visit, a deficiency is being cited and an Advisory Note (LIC9102) is being issued. An exit interview was conducted Administrator Anthony Coloma and Lead Staff Marianne Salonga, and a copy of this report including the LIC809C, LIC809D, LIC9102, and the appeal rights were provided at the end of the visit.