Routine inspection·July 10, 2024

Unannounced annual visit made out to this facility on 07/10/2024 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility staff person, Gloria Andres, who was briefly interviewed at this time. This LPA requested that the facility staff go ahead and contact the facility designated Administrator, Emma Villamil, to inform her that CCL was present at this time. The facility designated Administrator was unable to be present at this time for today's annual visit. Current census was 2 residents. It was learned that there were (2) residents under the care of hospice at this time. It was learned that there were (2) residents receiving services through home health at this time. It was learned that there was (1) resident diagnosed with dementia at this time. Facility staff files were supplied by the facility designated staff person Gloria Andres. This LPA requested for the facility staff files at this time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility hallway, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Additional food storage units were observed to be present and functional at this time. Laundry area, located in the garage area, was toured. Bleach, detergent, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Administrator certificate, #6031824740 for Emma Villamil, was observed to have an expiration date of 05/07/2024 at this time. It was learned that Emma Villamil was the only certified Administrator at this time. Medication cabinet, located in the facility entry way closet, was observed to be locked and made inaccessible to the residents at this time. First aid kit, located in a kitchen drawer, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguisher, located next to the kitchen area, was observed to have been annually purchased by this facility designated Administrator. The receipt, attached to the fire extinguisher, was observed to have been purchased from Home Depot on 01/13/2023 at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. A review of (2) facility resident files was conducted and noted on the following LIC 858. A review of (1) facility staff file was conducted and noted on the following LIC 859. The following forms and documents were requested to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interview