Routine inspection·April 14, 2025

Licensing Program Analyst (LPA) Raquel Hernandez made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Hernandez met with Administrator Lesley Vannoy. The capacity is (6) current census is (0). Administrator Vannoy stated currently facility is being converted to a different license. Administrator will contact licensing to close the facility soon. LPA Hernandez observed 0 residents at the home as Administrator Lesley Vannoy stated they have been moved to different homes under same license due to work being done on home on 02/03/2025. The facility is a five (5) bedroom, three (3) bathroom home with a kitchen/dining area, living room and attached garage. The facility is Residential Care Facility for the Elderly (RCFE). LPA Hernandez was accompanied by Administrators to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA Hernandez inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA tested water temperature to be at 106 degrees Fahrenheit. LPA Hernandez observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. Food Service: More than seven (7) days’ supply of Non-perishable foods and more than two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. Record Review: LPA Hernandez reviewed four (4) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPA Hernandez observed resident files reviewed were complete. LPA observed four (4) residents medications. LPA Hernandez observed Resident #1 (R1) and Resident #2 (R2) did not have (1) PM medication for both documented in Medication Administration Record (MAR). Deficiency will be issued. LPA Hernandez reviewed (2) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings. No issues were observed. Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) (LIC809D) and (LIC9102) was discussed and provided to Administrator Ernesto Custodio and Athina Custodio along with copy of Appeal Rights.