Routine inspection·August 1, 2023

Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced inspection on 08/01/2023 at 8:00 AM. LPA Lee met with two caregiver Ma Theresa Mata and Grace Roguel and explained the purpose of the visit. Ma Theresa, called administrator Cynthia Mojica who arrived approximately 30 minutes later. Administrator assisted with today’s visit. Administrator certificate # is 6006532740 and expires on 11/04/23. This facility is a single story building licensed to serve five (5) non-ambulatory residents with one (1) bedridden resident and approved for four (4) hospice waiver. LPA Lee inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. The facility has one public telephone in the dinning area and one in the kitchen. The facility has the required posters posted in the facility. LPA Lee observed the facility to be free of odor, clean and in good repair. LPA Lee observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA Lee observed sufficient seven days non-perishable and two days perishable food supplies. The resident bathroom water temperature measured at 109.5 degrees Fahrenheit which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers, smoke and carbon monoxide detectors are in good repair. Fire extinguisher was last serviced on 11/21/2022. Facility thermostat observed at 74 degrees Fahrenheit. LPA Lee checked medication storage and found medication to be locked away and inaccessible to clients. LPA Lee reviewed 5 out of 5 medication administration record (MAR) and 4 out of 5 MAR was not complete. First aid kit was checked and it was not complete. LPA Lee requested resident file for review. LPA Lee reviewed 5 out of 5 resident files and it was complete. LPA Lee reviewed 5 out of 10 staff files and 3 out 10 staff files were not complete. LPA Lee reviewed staff criminal record clearances and a review of staff records indicates that one (1) facility staff is fingerprint cleared, but not associated to the facility. As a result of this annual visit, the facility is not in compliance with Title 22 Regulation, and the deficiencies can be found on the LIC 809 D page. An exit interview was conducted, and a copy of these LIC 809 reports, LIC 809-D page, LIC 421GB and Appeals rights were provided to the facility.