Routine inspection·December 4, 2024

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required Annual Inspection. The facility file was reviewed prior to the visit. LPA Lopez identified herself, was granted entry by caregiver Benachloe Sabio. LPA discussed the purpose of the visit with caregiver Sabio and Licensee Bessie Pascual who later arrived and joined the visit. According to the facility’s license, there may be a maximum of six (6) residents in care, four (4) of whom may be non-ambulatory in rooms 1 & 5 in at any given time at the facility site. Facility is approved for 2 hospice residents. During today’s inspection, the facility’s current census is five (5) residents living at the facility. There were 2 residents present at the facility site during the inspection. LPA, accompanied by Licensee Pascual, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary and mostly in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Sink in bathroom #1 was observed to be leaking. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and activities. The facility’s ambient internal temperature was comfortable and compliant, at 70 degrees Fahrenheit (F). Hot water temperature at taps accessible to clients were also compliant: Kitchen sink measured hot water at 109.9 degrees F; sink in restroom #1 delivered hot water at 109.9 degrees F; and sink in restroom #2 delivered hot water at 111.6 degrees F. LPA observed that there were cockroaches located in bathroom #1. There was at least 2 days of perishable food, and at least 7 days non-perishable food present. Cooking/dining equipment and utensils were present, and all safely stored. There were no toxic chemicals/poisons accessible to residents. Medications were properly labeled, as required, and stored in a locked cabinet which LPA inspected. The facility - maintained medication logs which LPA reviewed. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] No pools or bodies of water on the premises. Per licensee Pascual, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher was present (01) and serviced within the last 12 months. First aid kit were complete and readily accessible. LPA spoke with staff and residents, and reviewed staff and resident records. During today’s visit there were 2 residents on the facility premise and three returned from their program during the visit. LPA interviews did not raise any licensing concerns. The files which LPA reviewed contained required documents. Confidential records were stored in a locked area. Required licensing postings were observed in a visible area of the facility. There were deficiencies observed and cited during today's annual inspection and may be found on the LIC809-D page of this report. An exit interview was conducted with Licensee Bessie Pascual and Assistant Administrator Blythe Pascual to whom a copy of this report along with the Licensee/Appeal Rights (LIC9058 03/22) were provided to Licensee Pascual at the conclusion of the visit. The signature below confirms the documents were received. LPA requested Assistant Administrator Pascual and Licensee Pascual to submit a current Designation of Administrative Responsibility LIC 308, Personnel Report LIC 500, Emergency Disaster Plan LIC 610-E, and Residential Infection Control Plan LIC 9282 (6/23), to the licensing office within 10 business days. Forms are available at www.ccld.ca.gov .