Routine inspection·January 9, 2025

This unannounced inspection is being conducted by Licensing Program Analysts (LPAs) Sean Haddad, Hanna Gough, and Nancy Guillen for the purpose of conducting a Required – 1 Year Inspection. LPAs met with Staff #1 (S1) Deisy Sakul and discussed the purpose of the inspection. Administrator (AD) Nidhi Nandwani arrived during the inspection. LPAs reviewed Infection Control requirements. At about 10:30AM, LPAs and S1 conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following: Structure: facility is a 6-bedroom, 3-bathroom, one-story house with a detached garage that is used for storage. There is a back yard with a patio cover for the residents. LPAs and AD observed 1 staff and 3 residents present at the facility. Resident Bedrooms: the 5 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: LPAs inspected the one staff bedroom. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested between 114.6 and 114.7 degrees F in the 2 resident bathrooms. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPAs observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the medication cabinet, after corrections. Toxins: observed locked in the garage, after corrections. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are paid. At about 11:30AM, LPAs reviewed 4 resident files and 3 staff files, interviewed 2 residents and 2 staff, and inspected medications for 4 residents. Facility does not handle resident money. CONTINUED. During the inspection, LPAs and AD observed the following: based on observation and interview, a staff has been living in the accessory dwelling unit (ADU) behind the garage for almost a month, but the ADU has not been fire cleared as a bedroom; based on observation, the facility did not ensure knifes, scissors, pesticides, dishwasher detergent, and other dangerous items were inaccessible to residents whose assessments do not allow for handling of such items; based on Guardian documents and interviews, the licensee did not ensure staff John Ferdinand Senewe observed by LPAs at the facility, who lives at the facility and has worked here for almost a month, was background cleared as their status is pending in Guardian; based on documents, the licensee did not maintain documentation of required training for 2 out of 2 staff; based on observations and admission, the licensee has been administering supplements but does not have doctor's orders for these supplements; and based on documents and admission, the facility did not conduct emergency disaster drills quarterly in 2024 as they only conducted 3 drills in 2024. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. Immediate civil penalties are being assessed. See LIC421IM, LIC421BG. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.