Routine inspection·October 9, 2024

Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, care giver Felimon Raturat to whom she discussed the purpose of the visit. Later Licensee/Administrator Dominique Mase joined the visit. According to the facility’s license, the facility has a maximum capacity of four (4) residents all of which may be non-ambulatory. During today’s inspection, there were a total of four (4) clients in care, all of which were non-ambulatory. This facility does not feature a secured perimeter or delayed egress doors. LPA, accompanied by licensee’s staff, 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. Client bedrooms contained the required furnishings. Doors, windows and screens, 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 client activities. The facility’s ambient internal temperature was compliant. There were two Refrigerator/Freezer units both of which had appropriate temperatures. There were two bathrooms accessible to clients both of which the hot water tap temperature was 116 degrees Fahrenheit (Continued on 809-C) (Continued from 809) There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Medications were labeled, as required. Confidential records were stored in locked areas. Upon LPA's arrival, she observed that keys were hanging from the medication storage cabinet locks and part of the cabinet did not have locks and one lock was damaged. There were medications in the cabinet, so a deficiency was issued. 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 extinguisher was serviced within the last 12 months. First aid kit were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed multiple staff and one client and reviewed multiple staff and client records/files. LPA interviews did not raise any licensing concerns. The files which LPA reviewed contained required documents. Licensee also presented proof of current/active business liability insurance and surety bond A deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D). A Plan of Correction was jointly developed with the licensee. An exit interview was conducted with Licensee/Administrator Dominique Mase, to whom a copy of this report, the LIC 809-D, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.