Routine inspection·June 27, 2025

Unannounced annual visit made out to this facility on 06/27/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility on-call staff person, Sandra Glover, who was briefly interviewed at this time. This LPA requested that she go ahead and contact the facility designated Administrator, Arlyn De la Cruz, to inform her that CCL was present at this time for an annual visit. This LPA was able to speak with the facility designated Administrator, Arlyn De la Cruz, on the phone and learned that she was at a personal engagement, funeral service, and would not be able to attend and be present for this annual visit at this time. She indicated that all authority was given to the caregiver, Sandra Glover, who was currently present to be able to sign and engage with this LPA at this time. It was learned that the husband, Juanito De la Cruz, was out of the facility at this time due to a personal medical appointment and would be available later on once his appointment had been fulfilled. Juanito De la Cruz did arrive later to this facility after this LPA had toured and was in the process of conducting the file review for this annual visit. Current census was 5 residents. Tour of the facility was conducted. Living area, dining area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient, in good repair, and able to meet the needs of the residents at this time. Kitchen area was toured. Cabinets and drawers were opened and the contents were reviewed at this time. Items for preparing, cooking, and serving meals unto the residents were observed to be sufficient and in compliance at this time. Cleaners and cleaning agents were observed to be locked and made inaccessible to the residents at this time. Fire extinguisher, located hanging on the wall adjacent to the refrigerator, was observed to have been annually inspected on 12/13/2024 by the local fire extinguisher company, Jorgensen Fire, and was in compliance at this time. Medication cabinets located in the kitchen area were observed to be locked and made inaccessible to the residents at this time. First aid kits were observed to be present and contained all of the required components at this time. Food supply, and food storage units, were observed to be sufficient and able to meet the needs of the residents at this time. This facility was observed to have, on hand at all times, a sufficient supply of 2-day perishable and 7-day nonperishable food quantities at this time. A tour of the facility bedrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. A tour of the facility restrooms was conducted. Grab bars, non skid mats, and toiletries were observed to be sufficient and able to meet the needs of the residents at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees at this time. A review of the laundry room was conducted. Bleach, detergent, and all other laundry supplies were observed to be locked and made inaccessible to the residents at this time. Garage area was toured. It was observed that this area was used mainly to store facility related items at this time. Exterior grounds of this facility were toured. Facility perimeter fence, side gates, and all other exits were reviewed at this time. Administrator certificate for the facility designated Administrator, Arlyn De la Cruz, was observed to be present with certificate number 7001834740 and set to expire on 11/24/2025. A review of (3) facility personnel files was conducted and noted on the following LIC 859. A review of (5) facility resident files was conducted and noted on the following LIC 858. 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. This facility was assessed a civil penalty in the amount of $500 on the following LIC 421 BG. Appeal Rights were printed and a copy was given to the facility representative at this time. Exit Interview