Routine inspection·June 16, 2025

On 6/16/2025, Licensing Program Analyst Arvin Villanueva (LPA) arrived at this facility unannounced to conduct their required annual inspection. LPA met with staff on duty, Luisa Saqusaqu (S5) and stated the purpose of this visit. The Administrator, Unaisi Waqalala, was notified and informed she was unable to be present during this inspection. Present during today's visit were 4 residents in care with 1 staff on duty (S1). Upon arrival LPA observed one resident at a dining table near the entrance of the facility. Another resident in the living room watching TV then eventually went to their bedroom. Per S1, residents just finished their lunch. One resident was observed in their bedroom listening to music with their headphones. Another resident was observed to be sitting in their bedroom, who then went to the bathroom during the physical inspection. LPA evaluated the physical plant with S5 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 5 of 5 resident bedrooms and were observed to be equipped with the required furniture and sufficient lighting throughout the facility. LPA measured the hot water temperature in 1 of 2 resident bathroom to be 113 degrees Fahrenheit. Room temperature was observed at 82 degrees Fahrenheit upon arrival. LPA observed sufficient seven day non-perishable and two day perishable food supplies. One fire extinguisher was observed and were last inspected on 4/3/2025. Smoke and carbon monoxide detectors were observed and tested and found to be operable at this time. 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. Exit doors have audible alarms. A medication box was observed inside the kitchen refrigerator and was found to be locked and not accessible to residents in care. Con't 809-C Outdoor area was inspected. Facility has a covered porch equipped with outdoor furniture for resident use. Facility has 2 side gate exits. The right side of the facility (garage side), LPA observed the gate to be in disrepair as evidenced door stopper sticking out with nails exposed. The side fence has part of it with nails sticking out. Photos were sent to Administrator. Review of 5 resident files (R1, R2, R3 R4, R5) include review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. One resident (R5) did not have their Admission Agreement on file available for review during this visit. Review of 5 staff files (S1, S2, S3, S4, S5) include review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. Administrator Certificate is current. It was noted that one staff (S4) was not associated to this facility. Record review of S4's training indicated that staff started on 11/15/2024. Additionally, it was discovered that S4's health screening was completed on 9/7/2023. Furthermore, review of S2's files revealed that S2 was associated to this facility on 5/30/25 and through interview with S3, S2 worked early in June 2025 to relieve S3. However, LPA discovered that S2's last health screen/TB test was completed on 6/19/2023. Administrator to submit current Liability Insurance Certificate, LIC500 and LIC308 to the Department. Based on today's visit, this annual will need continuation. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, following deficiencies were observed during today's visit: R5 did not have their Admission Agreement on file available for review. S2 did not have current Health Screening/TB test completed prior to working at this facility. S4 is not associated to this facility but per review of their training record indicated that their start date was on 11/15/24. Fence and side gate needs repair as evidence of nails sticking out. Citations will be issued when this annual is completed. The Department will return at a later date to complete the annual inspection. Exit interview was conducted and a copy of the report was provided upon exit.