Routine inspection·January 19, 2024

Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Araceli Ramirez. Administrator Natalia Verdugo arrived during the visit. The facility is licensed for a maximum capacity of 6 bedridden residents. The facility has a waiver for 6 hospice residents. During today’s visit, the facility had a census of 4 residents, none of which were bedridden and 1 of which was on hospice. The facility does not have a clearance for delayed egress or secured perimeter and LPA did not observe any aspects of delayed egress or secured perimeter. The Administrator for the facility is Natalia Verdugo and their certificate was valid and current. During today’s visit, LPA toured the facility and inspected each room of the facility, including resident and staff rooms, bathrooms for resident and staff use, kitchen, garage, common areas, and outside space. The facility has a fenced-in pool in the backyard that is locked and inaccessible to residents. According to Natalia Verdugo, no firearms or weapons are stored on the premises. The facility was found to be clean, safe, and in good repair with no pathway obstructions. The facility’s water temperature was measured at 119.5 degrees Fahrenheit and 119.8 degrees Fahrenheit in two common resident bathrooms. The facility’s internal temperature was measured at 71 degrees Fahrenheit. LPA observed unlocked hazardous and toxic chemicals in the facility kitchen, facility garage, and under the sink in a common bathroom for resident use. Administrator removed the hazardous and toxic items and locked them in the garage during the visit. LPA observed locked storage for resident medications and resident and staff files. Resident medications are stored in their original container and label. LPA observed a 2-day supply of perishable food and a 7-day supply of non-perishable food present at the facility. The facility refrigerator was kept at 37 degrees Fahrenheit, and the facility freezer was kept at 0 degrees Fahrenheit. Continued on LIC809-C page... LPA observed linens and hygiene products provided to the residents that are in good repair and sufficient to meet their needs. Staff present at the facility during the time of the inspection had a criminal background clearance, were associated to the facility, and had a first aid certificate. LPA reviewed multiple resident and staff records. Review of resident records revealed that 4 resident records were incomplete and were missing documents. Review of 5 staff files revealed that 3 staff records were incomplete and were missing documents. LPA spoke with staff and residents present at the facility during the time of the inspection and those interviews did not reveal any licensing or regulatory concerns. The Administrator will submit copies of the LIC500 Personnel Report, LIC610E Disaster Plan, and current liability insurance to the Department within 15 business days. The following deficiencies for unlocked hazardous and toxic chemicals, incomplete staff records, and incomplete resident records were cited per California Code of Regulations Title 22 and noted on the attached LIC809-D pages. An exit interview was conducted with Administrator Natalia Verdugo, whose signature below confirms receipt of a copy of this report, LIC811 Confidential Names List, LIC9102TV, and the Licensee Appeal Rights (LIC9058 01/16).