Routine inspection·August 8, 2024

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to conduct a Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Marga Ciruela. LPA also met with Administrator Ma Mevyl Deguzman and Manager Aries Deguzman, who arrived later during the visit. According to the facility’s license, the facility has a maximum capacity of six (6) residents, of which all may be ambulatory or non-ambulatory but none may be bedridden. Per LPA observation, LIC602 Physician’s Reports, and staff interviews: During today’s inspection, there were a total of five (5) residents in care, of which all were non-ambulatory and none were bedridden. The facility’s license does not include endorsements for delayed-egress doors or secured perimeter, and none of these were present. 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. Resident bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were working. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility’s ambient internal temperature was complaint at 76 F. Hot water temperature at taps accessible to residents were all compliant: Kitchen Sink was 117.3 F, Bathroom #1 Sink was 115.2 F, and Bathroom #2 Sink was 113.7 F. Appliances to preserve perishable food were also all compliant in temperature: Kitchen Refrigerator was 39 F and Kitchen Freezer was 0 F. Garage Refrigerator was 37 F and Garage Freezers were 0 F and 0 F, respectively. There was at least two (2) days of perishable food, and at least seven (7) days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] There were no sharp objects, toxic chemicals/poisons, active fireplaces, or open-faced heaters accessible to residents. Medications were labeled, as required, and stored in locked areas. Confidential records were stored in locked areas. 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 detector, night lights, emergency lighting, and facility telephone were all working. The facility’s fire extinguisher was serviced within the last twelve (12) months. A complete first aid kit was present and readily accessible. Required licensing postings were observed in visible areas of the facility. Licensee also presented proof of current/active business liability insurance. LPA reviewed all residents’ records and multiple staff records. LPA also interviewed multiple residents and multiple staff. During records review, LPA observed, and manager interview confirmed: While Licensee performed some emergency/disaster drills at the facility over the last year, they were less than the required frequency of one drill per shift, per quarter. Licensee also had not trained its staff on the facility’s Emergency/Disaster Plan (i.e., LIC610E) initially or within the last twelve (12) months. (Regulation requires staff to be trained on this topic as least once per year). Licensee had also not retrained its staff on the correct use of Personal Protective Equipment (PPE) within the last twelve (12) months. The last time staff received PPE training was 01-11-2023. (Regulation require staff to be trained on this topic at least once per year). Two (2) deficiencies were cited per California Health and Safety Code, and one (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D pages). Plans of Correction were jointly developed with the Licensee. LPA also issued Technical Assistance (TA) regarding staff auditory alert devices on exit doors (refer to the attached LIC 9102-TA page). An exit interview was conducted with Ma Mevyl Deguzman and Aries Deguzman, to whom a copy of this report, the LIC 809-D pages, the LIC9102-TA page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.