Routine inspection·March 7, 2025

Licensing Program Analyst (LPA) LaVette Farlow made an visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Staff, Lailani Pineda and was granted entry to the facility. Staff Lailani notified the administrator of my arrival. LPA was accompanied by Gina Cayanan to conduct a general overall inspection, which included, but was not limited to, the following: The facility has 5 bedrooms, 2 1/2 bathrooms, I staff bedroom, kitchen, dining area, living room, laundry area, garage and backyard. LPA completed a walk through of facility, review of records and medication audit. Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). LPA observed no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 74 degrees fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA inspected resident bathrooms; bathrooms were clean and appliances were found functional. Water temperatures tested at 114.7, 121.7 and 120.7 degrees fahrenheit. LPA advised licensee to monitor the water temperature. A technical advisory issued. LPA observed the facility does not have operational smoke detector or carbon monoxide alarms. A deficiency was cited. LPA observed the facility was not equipped with operational fire extinguisher it was last purchased or charged on 2/13/2024. A deficiency was cited. LPA observed the facility has a first aid kit, the kit was missing a current first aid book. LIC809 continued The first aid material was dated 2007. A technical violation was issued. Posters such as; the personal rights, CCL complaint poster, ombudsman, and license were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept in secure cabinets inaccessible to residents. LPA observed the resident medication cabinet was not locked and observed the licensee remove resident medication from a cabinet with dishes and was unsecured. A deficiency was cited. LPA observed Residents/Staff files were observed in the staff office area and made inaccessible. There are no bodies of water, firearms or ammunition in the facility. LPA observed the living room area exit to the backyard was blocked and obstructed by walkers and lounge chair. LPA requested the those items be removed immediately due it being a safety hazard. A deficiency was cited. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service : LPA observed 2 days of perishables and 7 days non-perishables food, pantry stocked and up to date. Facility has a variety of food available. Dishes, cups, and utensils were stored properly. Yards/Outside: One shaded patio, a side gate with entrance/exit to the facility the right side of the facility. Around 10:10AM, while touring the backyard LPA observed tree branches hanging very low blocking your ability walk freely. A deficiency cited. All outdoor pathways were free of obstructions. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. LPA observed the facility did not have a sufficient amount of hygiene product for residents in care, and some item are stored in staff common area. A technical violation issued. LPA observed the facility did not have a emergency to go bags for residents in care. A deficiency cited. Record Review: LPA reviewed resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings. LIC809C Continued LPA reviewed 3 out of 3 staff files and all 3 files were incomplete, or missing health screening and training record and current CPR records. Technical violation issued. LPA reviewed and audited 2 out of 2 residents medication and the audit was complete and matched the MARS. LPA observed that the facility last reviewed the emergency disaster plan on 03/01/2025. LPA observed that the facility did not have a record of quarterly emergency drills. A deficiency cited. Five (5) deficiencies and three (3) technical violations, and one (1) technical advisory were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, LIC809D, LIC9102TV, LIC9102TA were discussed and copies were provided to Administrator Gina Cayanan.