Routine inspection·November 29, 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 Evelyn Salazar, Administrator, who arrived at the facility a short time later. LPA disclosed the purpose of the visit. According to the facility’s license, the facility is licensed for six (6) residents, all of whom may be non-ambulatory. During today’s inspection, there were five (5) residents in care. 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 and in good repair. Pathways were free of obstruction and slip hazards. Non-skid mats were present in resident bathrooms. Equipment inspected was in working order. Hygiene supplies and Personal Protective Equipment were present. The facility had sufficient space and equipment to facilitate visitation, meetings, and resident activities. The facility’s internal temperature was 72 degrees F. Hot water temperature in bathroom sink accessible to residents was 120 degrees F. There were no sharp objects, fireplaces, or open-faced heaters accessible to residents; however, AJAX powder was observed in an unlocked cabinet below the sink in a bathroom accessible to a resident who has a diagnosis of dementia. 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 extinguishers were serviced within the last 12 months. First aid kit was complete and readily accessible. LPA interviewed staff and residents. LPA also reviewed staff and resident records/files. LPA observed that Resident 2 (R2) was admitted into the facility in May 2023; however, R2’s admission agreement was not signed by R2 or R2’s responsible party. Confidential records were stored in a locked file cabinet, and required licensing postings were observed in visible areas of the facility. Deficiencies are cited per California Code of Regulations, Title 22, on the attached LIC 809-D. Technical advisories were also provided to the administrator. Plans of Correction were jointly developed with the administrator. An exit interview was conducted with Evelyn Salazar, to whom a copy of this report, the LIC 809-D, LIC 9102TAs, the LIC 811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the end of the visit.