Routine inspection·May 2, 2025

On May 2, 2025, at 8:45 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and granted entry by Caregiver (CG) Cathyrine Manalastas. Administrator (ADMIN) Rosendo Carlo Miranda arrived around 9:00 AM at the facility and LPA Kim explained the purpose of the visit. The facility is licensed to operate for six (6) nonambulatory residents and has a hospice waiver for five (5) residents. The facility is a two-story structure located in a residential neighborhood. It consists of the following: five (5) resident bedrooms, two (2) staff bedroom, six (6) bathrooms, living area, dining area, living room, kitchen, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with ADMIN Miranda. There were no bodies of water or obstructions in the facility. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, and Resident Room 5. Staff room #1 is on the second story of the facility building and Staff Room #2 is in a building in the backyard. The facility sketch from fire clearance record designates staff room #2 as an office and storage building. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 106.1 degrees F to 110.5 degrees F. A comfortable temperature of 71 degrees maintained in the facility. Evaluation Report Continues on LIC 809-C LPA Kim observed the facility to be appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food both were available and maintained properly. Emergency food, emergency water, and emergency supplies are stored in the garage. There are three fire extinguishers mounted in the facility. The resident hallway fire extinguisher was serviced on February 26, 2025, the kitchen fire extinguisher was serviced on February 25, 2025, and the garage fire extinguisher was serviced October 3, 2024. During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE) stored in the garage. All mandated inspection control posters were posted. A working telephone (949-490 -4062) and an internet accessible device dedicated to the residents that can do video teleconference which both remain available. Last emergency drill was conducted on March 1, 2025. First aid kit is maintained and contains all the necessary elements. Evidence of liability insurance is effective September 1, 2024, and expires on September 1, 2025. LPA Kim conducted an audit of resident files (R1-R5), staff files (S1-S7), and medication and medication administration record that were all in order and complete. LPA Kim conducted three (3) resident interviews. A Deficiency was cited during this inspection visit per Title 22 Division 6 Chapter 8 of the California Code of Regulations. Staff Room #2 is a building in the backyard that is designated as a storage and office building and not as a bedroom. An exit interview was conducted, and a copy of this report and appeal rights were provided to Administrator Rosendo Carlo Miranda.