Routine inspection·April 22, 2025

On 4/22/2025, Licensing Program Analyst (LPA) Arvin Villanueva arrived unannounced at this facility to conduct their annual inspection visit. LPA initially met with staff on duty and explained the purpose of this visit. Staff then notified the administrator, Ma. Magnolia Tolon, and both the licensee and administrator arrived shortly after. Present today visit were 5 residents in care with 2 staff on duty. This facility has an approved hospice waiver for (3) residents at any given time. This facility also has, on file, a program to accept and retain residents diagnosed with dementia at this time. Administrator certificate was observed to be present and in compliance at this time. A tour of this facility was conducted. Facility is a one-story home located in a residential neighborhood. Kitchen area was toured. Cabinets and drawers were inspected. Food preparation stations, dishwashing station, and other areas intended for meal preps were also inspected. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. A tour of the dining area, living area, and all other areas intended for resident use was conducted. Medication cabinet, located in the hallway was inspected. The medication cabinet was observed to be locked and made inaccessible to the residents at this time. A tour of 5 of 6 resident bedrooms and 2 of 3 restrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperature was taken in 1 of 2 bathroom and measured at 117 degrees Fahrenheit. Room temperature during this visit was measured at 74 degrees Fahrenheit. {1 of 2} Linen closet, located in the resident hallway, was observed to contain a sufficient supply of towels, blankets, and linens to meet the needs of the residents at this time. Fire extinguishers, located throughout this facility, were observed to have been annually inspected on 3/5/25. Facility conducts quarterly emergency drills. Last drill was conducted on 4/1/25. First aid kit was observed to be present and contained all of the required components at this time. Exterior grounds of this facility were toured. A review of the facility perimeter fence, side gates, and exits was conducted and found to be in good repair at this time. A review of (3) facility resident files was conducted and noted on the following LIC 858. 1 of 3 resident did not have PRN authorization on file. Advisory was provided for resident to obtain one. Per discussion with the administrator, she will obtain one from resident doctor. LPA conducted a medication review of 3 residents. In one resident review, LPA observed one medication (M1) was prescribed with the dosage of 1mg (1000mcg); but facility has 800mcg on hand. A review of (3) facility personnel files was conducted and noted on the following LIC 859. 3 of 3 staff reviewed are associated to this facility. and 2 of 3 staff have current 1st aid/CPR certificate. 1 of 2 staff member on duty did not have a current first aid certification. During the discussion, the staff member believed that first aid was included in the certification. The following forms and documents were obtained during this visit: LIC 308 - Designation of administrative responsibility LIC 409 - Administration organization LIC 500 - Personnel report LIC 610E - Emergency Disaster Plan Deficiencies were observed from today's visit. Exit interview was conducted and a copy of this report was provided. {2 of 2}