Routine inspection·September 30, 2024

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPA Tea was greeted and granted entry into the facility by caregiver staff and explained the reason for the visit. Administrator (AD) Jessica Villanueva arrived shortly to assist with the visit. Facility is licensed for 6 non-ambulatory residents, with a hospice waiver for six. Currently there are five residents, of which two are on hospice during today's visit. Around 8:50 AM LPA Tea reviewed five resident files and three staff files. There were discrepancies noted in the review of resident and staff files. Administrator certificate expires on May 1, 2025. LPA Tea along with the Administrator toured the facility at 9:56 AM. LPA toured the physical plant, checked food service, and the first aid kit. The facility is a single-story home that consists of 3 resident bedrooms, 1 caregiver room, 1 1/2 bathrooms, living room, dining room, kitchen, sunroom and attached garage. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms and 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 around 117.1 F degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including bandages, tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen drawer. LPA also observed toxin substances to be locked and inaccessible to clients in care locked and secured in cabinets in the garage. The fire extinguisher in the kitchen was fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample seating with shade and two exit gates on the both sides of the facility are self-latching and operational. (continued on LIC809C) LPA observed emergency supplies, food and water supply in the kitchen and dining area. Facility provides activities based on resident interests. The residents watch television, do puzzles, reading books and newspapers and walk around the neighborhood. At the time of annual visit, residents were seen reading, doing puzzles and watching television. LPA reviewed medication storage and administration. Medications are stored in a locked cabinet in the office area. Medications are being administered per physician. LPA interviewed residents regarding their quality of care and spoke to staff present regarding care provided. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Administrator Jessica Villanueva and a copy of these reports were given to the facility along with a copy of the LIC 858; 859;809-D, 9102 and Appeal Rights.