Routine inspection·January 29, 2025

Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit for the purpose of conducting the required annual inspection. LPA was greeted and granted entry by caregiver staff after explaining the purpose for the visit. Administrator Donia Anaim was notified via telephone and later arrived to assist with the inspection. LPA observed that Administrator Donia Anaim has a valid Administrator certificate which expires on October 7, 2026. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, with a hospice waiver for six. The facility is a single story home with five private resident bedrooms, two shared resident bathrooms, one staff room, a living room, a family room, a kitchen, a dining room, an unattached two car garage, and a shed located in the backyard. LPA accompanied by the AD conducted a tour of the interior portion of the facility. On today's visit, LPA observed five residents in care, five of which are on hospice, and two caregiver staff present. LPA observed residents relaxing in their respective bedrooms and in the family room. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall in the entryway of the facility. LPA inspected all five resident bedrooms and they were observed to be free of hazards. LPA observed the resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident linens and blankets to be clean. LPA observed additional linens stored in a closet in the resident hallway. LPA observed Oxygen in Use signs posted in the appropriate resident doorways. LPA observed that the staff room is kept locked and inaccessible to residents in care. LPA inspected the two shared resident bathrooms. Resident bathrooms are clean. Bathrooms are equipped with grab bars and non-skid floors. Faucets and toilets were operational. Hot water temperature measured between 117.5 and 117.6 degrees Fahrenheit. LPA observed the kitchen has a two day perishable and seven day non-perishable food supply on hand. LPA observed kitchen appliances to be clean and operational. CONTINUED ON LIC809-C The four burner gas stove lights unassisted. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed chemicals and toxins to be stored in a locked kitchen cabinet under the sink. A fire extinguisher is located in the family room and it was observed to be charged and serviced as of December 12, 2024. LPA tested the wired smoke detectors/carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on December 5, 2024. The centrally stored medication is stored in a locked cabinet in the kitchen. LPA observed a First Aid Kit to be stored in the locked kitchen cabinet. LPA inspected the First Aid Kit and observed it to have all the required components. LPA accompanied by the AD toured the exterior portion of the facility. LPA observed the exterior portion to be free of obstructions and hazards. LPA observed an shaded outdoor seating area with furniture for resident use. The door leading to the unattached two car garage is kept locked and inaccessible to residents in care. LPA observed the facility has a three day emergency food and water supply stored in the two car garage. LPA inspected the shed located in the backyard. LPA observed the shed to be locked and inaccessible to residents in care. LPA observed the shed to be used for storage. The two perimeter gate on the north side of the facility are self-latching and can be opened in an evacuation. There are no bodies of water located on the premises. LPA reviewed all five resident files. LPA observed that Resident #1, Resident #2, Resident #3, and Resident #4 had Reappraisals that were outdated. LPA also observed that Resident #1, Resident #2, Resident #3, and Resident #4 did not have a valid Admission Agreement on file. LPA reviewed all five residents' medication and medication records. LPA reviewed two staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, deficiencies are being cited per the Title 22 of the California Code of Regulations. An exit interview was conducted with Administrator Donia Anaim. A copy of the report and Appeal Rights were provided.