Routine inspection·December 8, 2023

Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced required annual inspection. LPA identified herself, was granted entry into the facility, and met with Teresita Pedroso, licensee, to whom she disclosed the purpose of the visit. According to the facility’s license, the facility has a maximum capacity of six (6) residents, all of whom may be non-ambulatory. During today’s inspection, there were a total of six (6) residents residing in the home. This facility does not feature a secured perimeter or delayed egress doors. LPA, accompanied by licensee, toured the interior and exterior of the facility, and inspected the rooms. The facility was clean and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, and meetings. The facility’s internal temperature was within regulatory range. Refrigerators and freezers were operational and food was appropriately stored. Hot water temperature in bathroom used by residents measured at 113.3 degrees F. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Medications were labeled, as required, and stored in a locked cabinet. Confidential records were stored in locked areas. No pools or bodies of water were observed on the premises. Per the licensee, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher was present and had been serviced within the past 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA reviewed staff and resident records/files. A review of resident records reflected that resident appraisals had not been updated within the past 12 months. LPA also interviewed staff and residents; interviews did not raise any licensing concerns. Licensee also had proof of current/active business liability insurance. Administrator’s certification was recently renewed. A deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D), and a Plan of Correction was jointly developed with the licensee. Licensee was also issued a technical advisory and technical violations. An exit interview was conducted with Teresita Pedroso, to whom a copy of this report, the LIC 809-D, LIC 9102TVs, LIC 9102TA, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the end of the visit. Licensee’s signature on this report acknowledges receipt of copies of the reports and rights.