Routine inspection·May 13, 2025

On 5/13/2025, Licensing Program Analyst Arvin Villanueva (LPA) arrived unannounced at this facility to conduct their annual inspection visit. LPA met with Administrator Annie Lyn Rodriguez (AD) and stated the purpose of the visit. LPA was accompanied by Jenny Olson, CDSS Trainer, Arlene Krause and Katie Savin, Professors at California State University for training purposes. Present during this visit were 5 residents in care with 3 staff on duty including the AD. During this visit, LPA observed one resident in the living room sitting on a reclining chair throughout this visit. The other 4 residents were in their bedroom. 2 of the residents did had family visited. 2 outside agency staff were also present attending residents. Per interview with AD, there are no activity supplies to be reviewed at this time. LPA evaluated the physical plant with AD to ensure the health and safety of the residents in care. The facility is a one-story home located in a residential neighborhood. Areas inspected are including but not limited to the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA observed the inside of the facility to be clean and in good repair at this time. LPA inspected 4 of 6 resident bedrooms and were to be equipped with the required furniture and sufficient lighting throughout the facility. LPA measured the hot water temperature in 2 resident bathroom between 107 and 113 degrees Fahrenheit. Room temperature was observed at 71 degrees Fahrenheit. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Two fire extinguisher were observed and were last inspected on 3/5/2025. Smoke and carbon monoxide detectors were observed. LPA observed centrally stored medications, toxins, and sharp objects were kept locked and inaccessible to residents in care. No bodies of water was observed at this time. Fireplace was observed to be screened and non-operational at this time. {1 of 2} Outdoor area was inspected. Facility has 2 side gate exits. One of the gate is in need of repair as evidenced by the door is dragging at the bottom. The fence at the right side is also in need of repair. Debris on the right side of the house needs cleaning. Review of 4 resident files (R1, R2, R3 R4) include review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. Each resident reviewed had PRN authorization letter on file. Medication review of 2 residents include review of physician orders for over-the-counter medications. No issues were noted at this time. Review of 3 staff files (S1, S2, and S3) include review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. Administrator Certificate is current. No issues were noted at this time. Facility conducts quarterly disaster drill. Facility has a dementia and infection control plan. Administrator to submit current Liability Insurance Certificate, LIC500 and LIC308 to the Department. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies were observed during today's visit. Exit interview was conducted and a copy of the report was provided upon exit. {2 of 2}