Routine inspection·December 6, 2023

Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced Required Annual Inspection. LPA identified herself and was granted entry into the facility by Joy Millan, Caregiver, to whom she disclosed the purpose of the visit. Administrator, Amor Aguinaldo, was contacted via telephone and arrived a short time later. According to the facility’s license, the facility is licensed for six (6) residents, one (1) of whom may be non-ambulatory and one (1) bedridden. During today’s inspection, there were six (6) clients residing in the facility. The facility does not feature a secured perimeter or delayed egress doors. LPA, accompanied by administrator, toured the interior and exterior of the facility. The facility was clean, sanitary, and in good repair. Resident rooms had ample space and required furnishings. Pathways were free of obstruction and slip hazards. Doors, windows, and screens were present and sinks and toilets were in working order. Hygiene supplies and Personal Protective Equipment were present. The facility had sufficient space and equipment to facilitate visitation, meetings, and client activities. Hot water temperature in bathroom sink accessible to residents measured at 120 degrees F. No pools or bodies of water were observed on the premises. Per the administrator, 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 serviced within the last 12 months. First aid kit was complete and readily accessible. There were no sharp objects, fireplaces, or open-faced heaters accessible to clients. However, LPA observed Microban disinfectant cleaner and Clorox toilet bowl cleaner in the resident bathroom in an area that was accessible to residents in care. LPA interviewed staff and clients. LPA also reviewed staff and client records/files. The files that were reviewed by LPA contained required documents. Confidential records were stored in locked areas. Required licensing postings were observed in visible areas of the facility. Deficiency is cited per California Code of Regulations, Title 22, on the attached LIC 809-D. A plan of correction was jointly developed with the administrator. An exit interview was conducted with Amor Aguinaldo, to whom a copy of this report, the LIC 809-D, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the end of the visit. Her signature on this report confirms receipt of copies of the documents.