Routine inspection·May 29, 2024

Licensing Program Analyst (LPA) Daniel Pena conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Constancia Monar, Caregiver. Licensee/Administrator, Leonor Carmona later joined LPA. According to the facility’s license, the facility has a maximum capacity of six (6) residents, all of whom may be non-ambulatory. On the day of the visit, six (6) residents, two (2) caregivers and one (1) independent tenant were present. LPA verified that staff and independent person received background clearances. LPA toured the interior and exterior of the facility and inspected each room. The facility was sanitary, 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, meetings, and resident activities. There was at least two (2) days of perishable food, and at least seven (7) days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. Medications were labeled, as required, and stored in locked areas. No pool or bodies of water are present. Per Ms. Carmona, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. The staff and reviewed files which LPA reviewed contained required documents. Confidential records were stored in locked areas. Deficiencies were cited per California Code of Regulations, Title 22 (See LIC809-D), which resulted in assessment of an immediate Civil Penalty of $500.00 and thus charged and noted on the attached LIC421-IM. An exit interview was conducted with Ms. Carmona, to whom a copy of this report, the LIC809-D page, LIC421-IM, and Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.