Routine inspection·February 15, 2024

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Lead staff Melanie Gavina (S1). During the visit, LPA observed 4 residents and 2 staff. S1 called Administrator (ADM) Lynda Miguel and ADM stated S1 could give LPA tour and sign on her behalf. LPA toured the facility inside out with S1 which included the Living room, kitchen, dining room, 4 restrooms and 4 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways. While touring resident bedroom #3, LPA observed 7 containers of dish washing detergent on the ground. While touring the bathroom #2, which is located across from bedroom #3, LPA observed a bottle of dish washing detergent. (Photographs were taken.) Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 70 degrees F, and hot water temperature was measured at 118 degrees F in resident bathrooms. Fire extinguisher was serviced in May 10, 2023. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by S1, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on January 7, 2024. Page 1 out of 2. LPA reviewed facility records for 2 staff and 2 residents. While reviewing resident records, LPA discovered that residents R1, R2 and R3 are under the age of 60. LPA reviewed 2 resident medications and centrally stored medication records. LPA reviewed 2 residents P&I records. LPA conducted interviews with 2 staff (S1 to S2) and 2 residents (R1-R2). Deficiencies are being cited during today's visit, see LIC809-D. This report was reviewed with Lead staff Melanie Gavina and a copy of the signed report was provided. Page 2 out of 2.