Routine inspection·March 12, 2024

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced annual inspection visit and met with Administrator (ADM) Azucena Zipagan. The facility has 6 resident and 3 staff including the administrator. All residents are currently out of the facility attending day program at the time of the visit. LPA observed the following are displayed prominently and can be easily seen; facility license, personal rights, administrator certificate and visitor hours posters were observed at the main entrance. LPA toured the exterior and interior of the facility with the staff (S1), Assistant Administrator (AADM) and ADM. LPA inspected living room, kitchen, dinning area, restrooms, laundry room and garage. The facility has 4 resident bedrooms, 3 restrooms, 1 staff room. LPA observed medication, knives and toxic materials including but not limited to laundry detergents are observed in a locked cabinet not easily accessible. Non-skid mats and handle bars were observed in bathrooms. Room temperature was observed at 68 to 76 degree Farenheit (F) and water temperature in the bathroom and kitchen measured from 110 to 120 degree F. Refrigerator temperature was measured at 35 degree F, freezer temperature was measured at negative 10 degree F. LPA observed food supply is ample/sufficient for 2 days of perishable and 7 days non-perishable. Continued on LIC 809C page 1 of 2 continued from page 1 LPA observed the facility is equipped with fire alarm, fire sprinklers, carbon monoxide and smoke detector. Smoke alarm and carbon monoxide detector were tested and were found in good working condition. The fire extinguishers complies with the Fire Marshall's requirement. The interior hallways have working night lights. LPA observed the outside perimeter, ramps and walkways were free from any obstruction and debris. LPA reviewed 3 residents and 2 staff records. The records were complete and updated for the residents. The staff records were updated. No deficiencies and citations were issued for today's visit per California Code of Regulations Title 22. The exit interview was conducted with ADM Azucena Zipagan and signed copy of the report were provided to ADM. Page 2 of 2 End of Report