Routine inspection·February 11, 2025

On 02/11/25 at 8:32 AM, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA met with Licensee Milagros Dioso. LPA explained the purpose of the visit. Licensee assisted with today’s visit. Licensee’s administrator certificate # is 7014091740 and will expire on 11/21/25. The current census is 4 with 3 facility staff. This facility is a single story building licensed to serve six (6) non-ambulatory residents and approved for 2 hospice residents. LPA 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. LPA observed the facility to be free of odor, clean and in good repair. LPA observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 108.5 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Grab bars and non-slip mat were observed to be stable and in good repair at this time. Smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is located in kitchen and was last serviced on 01/13/25. The last fire drill was conducted on 12/05/24. LPA observed the facility has a has a public telephone in the common room and the facility has the required posters posted. Facility thermostat observed at 72 degrees Fahrenheit. LPA observed toxins located in the kitchen cabinet and kept locked and inaccessible to residents. LPA observed sharp knives kept locked and inaccessible to residents. LPA checked medication storage and found medication to be locked away and inaccessible to residents. LPA reviewed residents’ medications and medication administration record (MAR) and it was incomplete. Continued LIC 809-C It was observed that residents’ medications from 02/10/25 PM pass and this morning medication 8:00 AM pass was not initialed. The first aid kit was checked and contained the required components. LPA requested resident and staff files for review. LPA reviewed 4 out of 4 resident files and they were complete. LPA reviewed 2 staff files and 1 out of 2 staff files were complete. It was observed that the licensee didn’t have at least 20 hours of continuing education. LPA was also informed by the licensee that she is the direct caregiver to the residents. LPA reviewed staff criminal record clearances and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. The following documents will be email to LPA Lee by 02/18/25 end of day 5:00 PM (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (4) LIC 610 Emergency Disaster Plan (5) Proof of Current Liability Insurance 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, and Appeals rights were provided to the facility.