Routine inspection·May 9, 2025

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose of conducting the Required 1-Year annual evaluation using the Care Inspection Tool. LPA was greeted and granted entry by Caregiver Buenaventura Certeza and explained the reason for the visit. Administrator (Admin) Priscilla Celis was unable to come to the facility and authorized staff on duty to sign the report. Admin Celis holds a valid certificate expiring on July 5, 2025. The facility is a single story structure and is licensed to provide services for age range 60 and over for six non-ambulatory. A waiver was granted to provide hospice services to six residents at one time. During today's visit, there are five residents under hospice care and three caregivers on duty. LPA toured the physical plant with Caregiver Akiechelle Regala. Facility was clean and operational with the exception of the refrigerator and freezer which required a deep cleaning as food debris and stains were observed. LPA observed five resident bedrooms and three resident bathrooms. Resident bedrooms had all required furnishings. Bathrooms were found to be in compliance, clean, and operational. The hot water temperature measured at 119.4, 113.7, and 114.9 degrees Fahrenheit. All common areas were inspected including the attached two car garage. LPA reviewed the Emergency Disaster Plan (LIC610E) and observed sufficient emergency food and water in the garage and kitchen pantry. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food available in the kitchen. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction. The exit gate was self-closing and self-latching. LPA observed sufficient seating and shading. The fire extinguisher was mounted and serviced on April 11, 2025. The auditory devices and smoke/carbon monoxide detectors were tested and operational. Emergency evacuation drills are conducted quarterly. Last drill was conducted on February 26, 2025. The facility land line number, (949) 215-1591, was tested and remains available. The Complaint Poster, 'See Something, Say Something,' (PUB 475) was available and posted in the entry way in the correct size. LPA conducted a review of all residents and two staff files. Interviews were conducted with residents and staff. Medications were audited, and discrepancies were observed. The following items were addressed with the Admin by telephone at 11:47am: to deep clean refrigerator and freezer, to assemble emergency supplies in one central location, to complete the Medication Administration Record (MARs) at the time medications are administered, to maintain an accurate and up to date list of medications on the MAR, and to ensure as needed (PRN) medications are not transferred into a different container in advance. Based on the observations made during today's visit, a deficiency is being cited and Advisory Notes (LIC9102s) are also being issued. An exit interview was conducted with Caregivers Akiechelle Regala, Buenaventura Certeza, and Dionisio Tagle, and a copy of this report including the LIC809C, LIC809D, LIC9102s, LIC811, and the appeal rights were provided at the end of the visit.