Routine inspection·March 10, 2025

Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by care giving staff after explaining the purpose for the visit. Administrator (AD) Rowena Carrillo was notified via telephone and later arrived to assist with the inspection. LPA observed that Administrator Rowena Carrillo has a valid Administrator certificate which expires on June 24, 2025. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, one of which may be bedridden, and has a hospice waiver for six. The facility is a single story home with five resident bedrooms, one of which can be shared, one staff bedroom, three resident bathrooms, two of which are shared, a living room, a dining room, a kitchen, a laundry room, and an attached two car garage. LPA accompanied by the AD conducted a tour of the interior portion of the facility. On today's visit, LPA observed three residents in care, one of which is on hospice, and two care giving staff present. LPA observed residents eating breakfast in the dining room and relaxing in their respective bedrooms. LPA observed the See Something, Say Something poster (PUB 475) mounted on a wall in the dining room. LPA inspected the five 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. All resident beds had clean linens and blankets. LPA inspected the three 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 132.2 and 134.6 degrees Fahrenheit. LPA observed the staff room to be free of hazards. LPA observed the kitchen has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. The six burner gas stove lights unassisted. LPA observed knives and sharps to be stored in a locked kitchen cabinet. LPA observed the facility has a three day emergency food and water supply stored in the kitchen. CONTINUED ON LIC809-C Fire extinguishers are located in the entryway of the facility, in the resident hallway, and in the two car garage. Fire extinguishers were observed to be charged and up to date on service. LPA tested the wired smoke detectors which tested operational. LPA tested the individual carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on October 19, 2024. LPA observed a fire place in the living room and it was observed to not be in operation at the time of visit. The centrally stored medication is kept in a locked cabinet in the kitchen. A First Aid kit was observed be stored in the locked cabinet and it was observed to have all the required components. The door leading to the laundry room is kept locked and inaccessible to residents in care. LPA observed chemicals and toxins to be stored in in the laundry room. LPA observed additional linens to be stored in the laundry room. The door leading to the attached two car garage is kept locked and inaccessible to residents. The garage is used for storage. LPA and the 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 gate on the north side of the facility is self-latching and can be opened in an evacuation. There are no bodies of water on the premises. LPA reviewed all three resident files. LPA observed the facility did not have a Reappraisal on file for Resident #1 (R1), Resident #2 (R2), and Resident #3 (R3). LPA reviewed all three residents’ medication and medication records. LPA reviewed three staff files. All staff are background cleared and associated to the facility. Based on today's observations, deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Administrator Rowena Carrillo. A copy of the report and Appeal Rights were provided.