Routine inspection·October 23, 2024

Licensing Program Analysts (LPA) Maria (Mita) Partoza and Manuel Monter a conducted an unannounced required 1 year inspection visit and met with licensee/administrator (LIC/ADM) Olga Atienza-Bilan and stated the purpose of the visit. The facility is licensed to serve adults 60 and over of which 6 may be non-ambulatory and is subject to terms and condition of dementia waiver. LPA observed 5 out of 5 residents are present at the facility that have mild neurocognitive impairment, 1 staff was present during the visit. At 3:05 p.m. LPAs toured the facility inside and outside with LIC/ADM including but not limited to the kitchen, bathroom, dining room, living room, 5 residents rooms, garage, backyard and exterior walkways. The temperature inside the home was at 73 degrees Fahrenheit. The kitchen was observed to be sanitary and organized, knives and sharps were locked and not accessible to residents. LPA observed 2 days of perishable food and 7 days of non-perishable food. The refrigerator temperature was at 36 degree Fahrenheit and the freezer was at 22 degree Fahrenheit. LPA discussed with LIC/ADM food safety and storage. Under the sink cabinet is used to store cleaning supply kept locked and not accessible to residents. The water temperature measured at 108 to 112 degrees Fahrenheit. Resident's room (R1 to R5) have sufficient storage. The facility is equipped with a fire, smoke and carbon monoxide alert system that is in good working condition, night lights on the hallway are in good working condition. The hallway are free from obstruction. LPA observed that medications are kept locked and inaccessible to residents. The first aid kit is complete and is easily accessed by staff. page 1 of 2 - see LIC 809C The backyard, walkways, ramps and patio are free from debris and obstruction. The facility screen windows were observed to be in good repair. The washer and dryer located at garage are in good working condition. Laundry soap and cleaning supplies are locked and not accessible to residents in care. LPA reviewed 3 out of 5 resident records such as the centrally stored medication and destruction record (CSMDR), admission agreement, needs and services plan, health screening and observed records to be current and updated. LPA reviewed 2 out of 2 staff records including but not limited to required training, first aid/CPR training, health screening and background clearance. All staff have criminal record clearance/fingerprints. The facility has conducted an fire and earthquake drill on 06/1/2024. Deficiency was cited during today's visit for based on California Code of Regulations (CCR) Title 22 87555(b)(21). See LIC 809D. An exit interview was conducted during today's visit with Licensee/administrator Olga Atienza-Bilan. A copy of the report and appeal's rights was provided. end of report page 2 of 2