Routine inspection·January 13, 2025

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 Manuel Santiaguel. LPA discussed the purpose of the visit with Administrator Frederick Locsin. Licensee Donnah Locsin later arrived and joined the visit. According to the facility’s license, there may be a maximum of six (6) residents all of whom may be non-ambulatory in at any given time at the facility site. Hospice is approved for 4. During today’s inspection, the facility’s current census is 6 residents living at the facility. There were 6 residents present at the facility site during the inspection. LPA, accompanied by Licensee Locsin, toured the interior and exterior of the facility, and inspected each room. The facility was clean, 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 activities. The facility’s ambient internal temperature was comfortable and compliant, at 71 degrees Fahrenheit (F). Hot water temperature at taps accessible to residents were also compliant: kitchen sink measured hot water at 114.4 degrees F; sink in restroom #1 delivered hot water at 109 degrees F; and sink in restroom #2 delivered hot water at 106.3 degrees F. 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 or poisons accessible to residents. Medications were properly labeled, as required, and stored in locked area. LPA inspected the medication cart and found that medications were properly labeled, stored and locked. The facility-maintained medication logs which LPA reviewed. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] The pool on the facility premise was gated, in good repair and kept locked. The fence was designed and installed so the fence is not removable in any portion of it. The fence was constructed so that it does not obscure the pool from view and may not easily be climbed, broken or stretched. There are no windows or doors that provides direct access to the pool area. The openings of the gate between railings do not exceed 4” from the ground to the surface. Licensee agreed that the fencing will remain in place and properly functioning whenever there are licensed residents in care. Per licensee, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguishers were present (02). First aid kit was complete and readily accessible. During today’s visit there were 6 residents on the facility premise of which 3 were interviewed. LPA’s visit 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 no deficiencies observed or cited during today's annual inspection. An exit interview was conducted with Licensee Donnah Locsin to whom a copy of this report along with the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit. The signature below confirms the documents were received. Licensee provided a current copy of Designation of Administrative Responsibility LIC 308 and Emergency Disaster Plan LIC 610-E to LPA during the inspection. LPA requested Licensee Locsin to submit a current Personnel Report LIC 500 to the licensing office within 10 business days. Forms are available at www.ccld.ca.gov .