Routine inspection·January 13, 2024

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator (ADM) Olga Atienza-Bilan . During visit, LPA observed 5 residents and 2 staff. LPA toured the facility inside out with ADM which included; the Living room, kitchen, dining room, restrooms and residents bedrooms. The staff area of the facility was also inspected. Front yard and backyard were inspected. There was no obstruction to block the walkways. Two day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication cabinet, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 75 degrees F, and hot water temperature was measured at 108 degrees F in resident bathrooms. While touring the kitchen, LPA requested to see the inside of the garage. LPA observed the door to the garage gets jammed and is difficult to close. ADM stated she has called repairman to address the door. While touring the backyard, LPA observed, bedroom #3's sliding door, does not have a screen. ADM stated it was removed because it was broken. (Photographs were taken.) Fire extinguisher was serviced in January 2024. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. ADM stated the last fire drill conducted was on December 2023, but doesn't have a log. Page 1 out of 2. LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 3 resident medications and centrally stored medication records. LPA conducted interviews with 2 staff (S1 & ADM) and 3 residents (R1-R3). Deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. Exit interview was conducted with Administrator Olga Atienza-Bilan and a copy of the signed report & appeal rights were provided. Page 2 out of 2.