Post-licensing visit·November 26, 2024

Unannounced Post Licensing visit made out to this facility on 11/26/2024 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility caregivers, Samuel Saahene and Myrna Sibayan, who were briefly interviewed at this time. This LPA requested that they go ahead and contact the facility designated Administrator to inform her that CCL was present at this time. Anabelen Vallarta arrived later to this facility while this LPA was conducting this post licensing visit. Current census was 2 residents. It was learned that this facility currently has (2) residents under the care of hospice at this time. It was learned that this facility has a program to be able to accept and retain dementia residents at any given 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 near the facility employee hallway office, 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 near the garage area, was toured. Bleach, detergent, and all other cleaning supplies were reviewed to make sure that they were locked and made inaccessible to the residents at this time. Administrator certificate for Sharon Drequito was observed to have been completed with number 6069174740 that was set to expire on 04/07/2026 and in compliance at this time. Medication cabinet, located in the facility employee office area, was observed to be locked and made inaccessible to the residents at this time. First aid kit, located hanging on the kitchen wall, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguisher, located hanging on the kitchen wall, was observed to have been recently purchased from the local Costco store on 04/06/2024 and in compliance 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. 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 representative at this time. Exit Interview