Routine inspection·October 5, 2023

Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual inspection on 10/05/2023 at 10:40 AM. LPA Martinez met with Angelica Velasquez and stated the purpose of today’s visit. LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. Administrator certificate expired on 06/20/2023, and Angelica Velasquez has submitted their renewal application to the Department on May 28, 2023. The facility is licensed for 6 non-ambulatory residents. There are currently 6 residents who reside at this facility. The facility has an approved hospice waiver for 2. LPA Martinez toured the facility with Angelica Velasquez on 10/05/2023 at 11:30 AM. LPA Martinez reviewed two staff files and two client files. The facility files are maintained. LPA Martinez reviewed two medication administration records, and the records are complete and maintained. The facility has an infection control plan and a natural disaster plan. The facility has a first aid kit. The facility smoke detectors, carbon detectors, and fire extinguishers are in good repair. The exterior emergency exit gate is in good repair. Resident bedrooms and bathrooms are furnished and in good repair. The facility common areas are in good repair and furnished. The facility has a public telephone, and has an area for activities. The facility temperature measured at 77 degrees, and the facility water temperature measured at 109 degrees. The facility has an adequate food supply, and the kitchen is sanitary and clean. Resident bedrooms and bathrooms are furnished and sanitary. The exterior of the facility is clear of debris, and the facility has a covered patio for resident use. Based on this annual inspection, the facility is in compliance with California Code of Regulations, Title 22 and Health and Safety Code. There were no deficiencies cited at this time. An exit interview was conducted, and copy of this report was provided to the facility.