Routine inspection·February 21, 2025

Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by Administrator Marlyn Salazar after explaining the purpose for the visit. LPA observed that Administrator Marlyn Salazar has a valid Administrator's certificate which expires on May 15, 2025. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for two residents, of which one may be non-ambulatory, and has a hospice waiver for two. The facility is a single story home with six bedrooms, two of which are for residents, three bathrooms, two of which are for residents, two living rooms, a dining room, a kitchen, and an attached one car garage. LPA accompanied by the AD conducted a tour of the interior portion of the facility. On today's visit, LPA observed one residents in care and two staff present. LPA observed the resident sleeping in his respective bedroom. LPA observed the See Something, Say Something poster (PUB 475) mounted on a wall by the entryway of the facility. LPA inspected the two resident bedrooms, and they were observed to be free of any hazards. LPA observed the resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. Resident beds had clean linens and blankets. LPA observed additional linens are stored in a hallway closet. LPA inspected the two resident bathrooms. Resident bathrooms are clean. Bathrooms are equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 117.2 and 119 degrees Fahrenheit. LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. The four burner gas stove lights unassisted. LPA observed kitchen knives are stored in a locked kitchen cabinet. LPA observed cleaning supplies and toxins are stored in a locked kitchen cabinet under the sink. CONTINUED ON LIC809-C A fire extinguisher is located in the kitchen and in the resident hallway. Fire extinguishers were observed to be charged and up to date on service. LPA tested the wired smoke detectors/carbon monoxide detectors which tested operational. LPA observed medications were being stored on top of a shelf in the living room. LPA observed a First Aid kit to be stored in the living room and it was observed to have all the required components. The door leading to the attached one car garage is kept locked and inaccessible to resident. The garage is used for storage. LPA and AD conducted a tour of the exterior portion of the facility. LPA observed the exterior portion to be clear of obstructions and hazards. LPA observed a shaded outdoor seating area with furniture for resident use. The perimeter gates on the north side and southside of the facility are self-latching and can be opened in an evacuation. There are no bodies of water on the premises. LPA reviewed the one resident files. All the required documentation were present and current in the resident file reviewed. LPA reviewed the one residents’ medication and medication records. LPA observed the facility was providing one medication to the resident without a proper Physician's order. LPA reviewed two staff files. LPA observed that Staff #2, who was present at the time of visit, does not have a proper criminal record clearance. Based on the observations made during today's visit, deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Administrator Marlyn Salazar. A copy of the report and Appeal Rights were provided.