Routine inspection·October 18, 2024

On 10/18/2024, Licensing Program Analyst (LPA) Tobola and Jian conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by Caregiver, Bok Eugenio. Administrator, Marian Torres Cua was contacted and arrived later in the visit. The facility currently provides care for 5 residents, none of which are receiving hospice services and some of which with a diagnosis of dementia. LPA continued with a tour of the facility with staff, facility found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers located in kitchen was found to be charged. Smoke and carbon monoxide detectors located throughout the facility were in working order. There was a sufficient supply of both perishable and nonperishable foods as required, with food stored in the kitchen, sufficient for residents in care. Food supply is replenished constantly throughout the week and stored properly. Facility provides a wide variety of meal preferences and preparation while also ensuring proper dietary restrictions are followed. Cleaning supplies stored under the kitchen sink were found to be secured. There was a supply of hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings and bedding items. During inspection LPA observed resident's (R5) bed to be equipped with two half rails extending the full length of their bed, without physician approval. Licensee contacted R1's physician and will be requesting for an order and exception for R1. There is a single outdoor patio for resident use, all equipped with appropriate shading Continued onto LIC809-C LPA conducted a sample file review for residents and found that all five residents are in need of updated appraisals. Technical Violation issued. Upon a spot check of staff files, LPA found that caregiver staff have current 1st aid and CPR and annual training completed. However, staff S1 & S2 did not have current health screening on file. Technical Violation issued. Lastly, A spot check of medications was conducted and found that all medication counts and records to be in order. Marian Toress Cua's Administrator Certificate, 7001432740 is currently active through 8/25/2025. LPA requested the following documents be sent to CCL by COB 11/1/2024: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan Liability Insurance Deficiency cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties