Post-licensing visit·June 26, 2025

On 6/26/2025, Licensing Program Analyst, Arvin Villanueva (LPA) arrived at this facility to conduct their post-licensing inspection. LPA met with designated staff, Buluo Matamadua (S5), and explained the purpose of the visit. Present during this visit were 3 residents in care with Present during this visit were 3 residents in care with 2 staff on duty (S1 and S5) 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 inspected 3 of 3 resident bedrooms. Room #1, based on facility sketch, is currently shared by 2 residents. However, LPA observed one night stand between the two beds. Also in room #1, one resident drawer is in need of repair/replacement as evidenced by wood chipped off. Inside this drawer, LPA observed hygiene and grooming supplies. Per review of LIC602A, resident(s) is/are present at this facility is/are at risks if allowed to have access to these personal grooming and hygiene items. Room #1 also has its own bathroom. LPA observed hygiene and grooming products accessible to resident(s) who is/are at risks if they have access to these products. In this bathroom, LPA observed the toilet to be missing a toilet seat. Also, in room #1, the sliding screen door has been detached. Per interview with S5, one resident removed it. In room #2, LPA observed the floor at the entrance has part of it chipped off. In the bathroom at the hallway, a grab bar in front of the toilet was loose. Advisory was provided for necessary repair. Inspection of the kitchen was conducted. LPA observed knives and scissors inside one of the kitchen drawers, accessible to residents in care. The facility maintains sufficient seven day non-perishable and two day perishable food supplies. LPA measured the hot water in one resident bathroom and was measured at 106 degrees Fahrenheit. Room temperature was maintained at 76 degrees Fahrenheit. Fire extinguisher was last serviced on 9/4/2024. Smoke and carbon monoxide detectors were observed. {1 of 2} Outdoor area was inspected. Facility has one side gate exit. The gate does not self lock properly. Advisory was provided to S5 to make necessary repair. Fence were observed to be in good repair at this time. Review of 4 resident files (R1, R2, R3, R4) include review of Admission Agreement, Physician Reports, Needs and Services Plan, and Ambulatory Status. Through record review and interview, a resident passed away recently and their death report was not yet submitted to the Department and it is past the reporting requirement of 7 days following the incident. Resident medications were not reviewed during this visit. Review of 7 staff files (S1 - S7) include review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. Administrator Certificate is current. Per review of Guardian, it was discovered that S1 is not associated to this facility. S1 immediately left the facility and another staff (S7) who is associated to this facility came shortly after to relieve S1. Facility conducts quarterly disaster drill. 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}