Routine inspection·June 18, 2025

On 6/18/2025 Licensing Program Analysts Sommer Hayes and Arvin Villanueva (LPAs) arrived at this facility unannounced to conduct an annual inspection. LPA initially met with staff on duty, and stated the purpose of the visit. The Licensee/Administrator, Angelita Dayoan (AD), was notified of the visit and arrived shortly after. Present during this visit were 6 residents in care with 2 staff on duty. During this visit, LPA observed one resident at the dining table having a meal. One resident in the living room watching TV with their visitor. Other residents were in their bedrooms. One outside agency staff arrived during the visit. LPAs 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. LPAs observed common areas to be clean and free from debris and obstructions. All 6 resident bedrooms were observed to be fully furnished and have enough space to accommodate resident belongings. Three bathrooms were observed to be well maintained and sanitized. Facility maintains an adequate amount of linen supplies. The room temperature was observed at 75 degrees Fahrenheit upon arrival. Hot water temperature was taken in 2 resident bathrooms and were measured between 127 and 133 degrees Fahrenheit. In the kitchen area, the LPAs observed a small live cockroach inside one of the sliding drawers. Additionally, during an inspection of the kitchen freezer, two dead cockroaches were found at the bottom. In an interview, the AD stated that pest control services are used. AD provided pest control service agreement from November 2023 to October 2024; however, AD was unable to provide continuing pest control contract or any supporting documentation as proof of services being done after October 2024. One of the kitchen cabinet door was observed to be falling off when this LPA opened the door. During this visit, a person came to fix the cabinet door. Inside the refrigerator, LPAs observed a locked black metal container. {Con't to LIC809-C} The facility maintains nonperishable foods for a minimum of 7 days and perishable food for 2 days. Pantry was also observed to have adequate food supplies. Inside the pantry, LPAs observed a container which read CBD gummies on the top shelves. Per interview with staff on duty, that belongs to one of the staff. Staff on duty immediately took the CBD gummies. The garage houses additional freezers and refrigerators. Additional food supplies were observed in the garage. In one of the cabinet that is unlocked, contained food supplies and at the bottom shelf of the cabinet, LPAs observed chemicals including paint containers and Flex Seal aerosol spray bottle. Staff on duty immediately removed the items and placed them inside a locked cabinet. Fire extinguishers are maintained in the facility and were observed to be fully charged and were last serviced on 5/6/25. Medications, cleaning supplies, and sharp objects were observed to be locked and inaccessible to residents in care, except those found inside the garage cabinet. Smoke detectors were observed to be in each bedrooms and hallways and at least one carbon monoxide detector was observed. Outdoor area was inspected. Facility has 1 side gate exits. Facility has a swimming pool which was observed to be gated, locked with padlock and not accessible to residents in care. Gate and fences were observed to be in good repair at this time. LPAs observed one window screen and one sliding door screen to be in disrepair. Advisory was provided to AD to make necessary repairs. Review of 6 resident files (R1, R2, R3 R4, R5, R6) include review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. Each resident binder had PRN authorization letter on file. A medication review for two residents was conducted by the LPAs and the AD, which included an assessment of physician orders for over-the-counter medications. During the review of Resident R5's medications, the LPAs identified three medications that did not comply with the physician’s orders. The medication Docusate (Stool Softener) was prescribed at 250 mg, but the facility only had 100 mg capsules available. According to interviews with the AD and staff, they administer two capsules, which still results in a 50 mg shortfall. Additionally, Turmeric was prescribed at 450 mg, but the facility had 500 mg capsules. Krill oil was ordered at 500 mg, while only 400 mg capsules were on hand. Furthermore, one of R5's medications, Metformin, was found to be expired. {Con't to LIC 809-C} 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 copy of 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. The following deficiencies were observed during this visit: Cockroaches we observed inside a sliding drawer and inside the kitchen freezer. Hot water temperature in 2 resident bathroom faucets were between 127 and 133 degrees Fahrenheit. Container of CBD Gummies belonging to staff was observed inside the food pantry. 3 medications were not in compliance with doctor's orders. One resident medication was observed to be expired. Chemicals was being stored with food supplies inside a cabinet in the garage. Exit interview was conducted and a copy of the report was provided upon exit. Per California Code of Regulations, Title 22, Division 6, Chapter 6, deficiencies were observed during this visit. An exit interview was held, and a copy of this report and appeal rights were provided.