Routine inspection·March 7, 2025

Licensing Program Analyst (LPA) William Vanegas made an unannounced inspection for the purposes of conducting an annual inspection. Upon arrival LPA Vanegas was greeted and granted entry to the facility by House Manager (HM) Arnold Mendoza, and LPA Vanegas explained the purpose of the inspection. LPA Vanegas set up equipment and began a tour of the facility and observed the following. This is a one storied home with seven bedrooms one of which is a staff bedroom, and six of which are resident bedrooms. This facility has four bathrooms, and an attached two car garage. LPA Vanegas observed kitchen area to be clean and free of debris and mildew. LPA Vanegas observed there to be a gas stove, microwave, dishwasher, refrigerator, washer, and a dryer. All were in good repair and tested operational. LPA Vanegas observed a two day supply of perishable food, and a seven day supply of non-perishable food, and a sufficient amount of emergency water for residents in care. LPA Vanegas observed all resident rooms to have the required furnishings such as a lamp, chair, enough storage space, a bed, and clean linens in good repair; meaning no strains or tears. Bedrooms are large enough to walk about freely, and no obstructions are blocking entry ways. LPA Vanegas observed all resident bathrooms to be free of any mildew or debris, as well as having all required furnishings such as a shower chair, slip resistant floor matts, and grab bars. Water faucets, and toilets tested operational, and water tested between 112.8 and 113.2 degrees. LPA Vanegas observed outside of the facility to be clean and free of any debris along emergency exit routes. Side gates are self latching and unlocked, there is an outdoor shaded sitting area, and backyard is large enough to participate in outdoor activities upon resident request. CONTINUED ON LIC809C LPA Vanegas observed all toxins, sharps, and medications to be locked away and inaccessible to residents in care. LPA Vanegas observed all fire extinguishers to be up to date, and fully charged. LPA Vanegas observed all smoke detectors to be in good repair and operational. LPA Vanegas observed first aid kit to have all required items such as adhesive tape, tweezers, scissors, bandages, a thermometer, and a first aid manual. LPA Vanegas observed infection control plan, and disaster preparedness plan to be fully up to date, and filled out correctly. LPA Vanegas reviewed centrally stored medications log with HM Arnold Mendoza, and observed for all medications to be documented correctly, and per LPA Vanegas review medications are being administered per physicians orders. LPA Vanegas reviewed two staff files and five resident files all files (staff and resident) had all required documents, and annual staff training was up to date and documented. Based on observations made during today's visit no deficiencies will be issued per title 22 Chapter 8 Division 6 of the California Code Of Regulations. An exit interview was conducted with HM Arnold Mendoza, and a copy of this report was left at the facility.