Routine inspection·June 18, 2025

Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing an annual required inspection. LPA arrived at the facility and was greeted and granted entry by caregiver and LPA explained the nature of the visit. LPA spoke with Mariza Oliva, Administrator via telephone call. There are two residents at the facility and there is one resident receiving hospice services currently. LPA began the tour of the inside and outside of the facility. LPA observed required department postings throughout the facility. Facility stays within the capacity limitations. There is a minimum of one week of non-perishables foods and two days of perishables foods available. There is additional food storage in storage in a spare refrigerator located in the garage. The facility is maintained at a comfortable temperature. LPA inspected that medication is centrally stored in a safe locked storage cabinet located in the kitchen. LPA reviewed medication and observed medication was labeled and stored inaccessible to residents in care. LPA inspected the bathroom. LPA measured the hot water temperature which measured 108.6 Fahrenheit degrees. All bathrooms observed to have a supply of soap, toilet paper and towels. Bathrooms are equipped with required safety measures such as non-skid mats and grab bars. Lighting is sufficient to ensure safety and comfort. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPA observed that toxic chemicals, cleaning solutions and disinfectants are stored in a locked storage cabinet. The facility has an available clean supply of linens. LPA inspected residents’ bedrooms which has sufficient lighting to ensure the safety and comfort. All bedrooms observed to have all required components. Storage space is provided for residents in their bedroom. Smoke/carbon monoxide detectors were tested and found to Continued on LIC809-C be operational. LPA toured the outside of the facility and observed outdoor passageways are free of obstructions. LPA observed there are shaded seating areas for residents’ enjoyment, there is additional shaded seating in the front patio of the facility. LPA observed a swimming pool in the backyard with a fence around it. LPA observed the pool gate entry door which opens towards the pool. The fence has a lock at the gate door for inaccessibility. LPA measured the pool fence which measured 5.46ft from base of the floor to the top of the fence and it was observed to enclose the entire pool area. LPA observed a fire extinguisher between dining room and bedroom hallway with service date January 13, 2025. Fire drills are to be conducted quarterly. Facility has a second floor which is inaccessible to residents in care, begin of staircase has a gate. There are no residents residing on the second floor of the facility. LPA verified resident in care do not have access to the second floor. LPA began review of records. LPA reviewed two resident records. All the required documentation was present and current in the residents’ files reviewed. LPA reviewed one employee records. All employees present have a criminal record clearance and are associated to the facility. LPA observed records reviewed have a current First Aid certificate. Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the facility representative and a copy of this report was provided to the facility.