Routine inspection (multi-day)·January 27, 2025

Licensing Program Analysts (LPAs) Rebecca Borunda and Carmen Lopez conducted an unannounced Case Management Annual Continuation visit. The facility file was reviewed prior to the visit. LPAs were greeted by, identified themselves to, and explained the purpose of the visit with Administrator Natalia Verdugo. The facility is licensed for a maximum capacity of 6 bedridden residents, with a hospice waiver for 6 residents. During today’s visit, the facility had a census of 5 residents. The Administrator for the facility is Natalia Verdugo and their certificate was valid and current. During visits on 12/17/2024 and 1/27/2025, LPAs toured the facility and inspected each room of the facility, including resident 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. LPAs did not observe any aspects of delayed egress or secured perimeter. The facility was found to be clean, safe, and in good repair with no pathway obstructions. The facility’s water temperature was measured at 119.2 and 111.2 degrees Fahrenheit in bathrooms for resident use. The facility’s internal temperature was measured at 69 degrees Fahrenheit. LPA observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. According to Natalia Verdugo, no firearms or weapons are stored on the premises. LPA also observed locked storage for resident medications and resident and staff files. LPAs observed that 5 of 5 resident medications are not stored in their original container and are instead stored in multi-day pill boxes. LPA observed a minimum of 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 40 degrees Fahrenheit, and the facility freezer was kept at 0 degrees Fahrenheit. LPA observed linens and hygiene products provided to the residents that are in good repair and sufficient to meet their needs. LPAs reviewed multiple resident and staff records. Continued on LIC809-C page… During the visit, LPAs determined that Staff 1 (S1) was not associated to the facility and did not have an active fingerprint clearance. [Administrator was provided with an LIC811 Confidential Names List to identify S1] Interviews with S1 and Administrator revealed that S1 had been working at the facility for more than 5 calendar days. LPAs notified Administrator that S1 could not be present or working at the facility until S1 was associated to the facility. LPAs observed S1 leave the facility during the visit. 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 following deficiencies were cited for medication stored in non-original containers and for staff without criminal background clearance and noted on the attached LIC809-D pages. Additionally, a civil penalty in the amount of $500 was assessed for staff without a criminal background clearance and noted on the attached LIC421BG form. LPAs also provided Administrator with an LIC9102TV Technical Violation regarding reporting requirements. An exit interview was conducted with Administrator Natalia Verdugo, whose signature below confirms receipt of a copy of this report, the LIC811, the LIC9102TV, and the LIC421BG and the Licensee Appeal Rights (LIC9058 3/22).