Routine inspection·February 13, 2025

On February 13, 2025, at 12:45 PM, Licensing Program Analysts (LPA), Kenneth Madrigal and Manuel Monter, conducted an unannounced Required 1 - Year Visit. LPAs stated the purpose of the inspection visit and met with Staff 1 (S1) who contacted Olivia Velasquez, Administrator Designee (AD) and was granted entry to the facility. Olivia stated that “Judith Morales, the Administrator (ADM) is out of the country.” LPAs called Judith Morales on the phone, but ADM did not pick up the phone, so LPAs left a voicemail. AD stated there are 7 facility staff, and 17 residents present at the time of the visit. The facility has 16 resident rooms, 8 resident bathrooms, one dining room, two living rooms, one office, one kitchen area, one laundry area, one storage area, and 98 sprinklers. During today's visit, the LPAs toured the facility inside and out with AD. In the kitchen area, all the sharps and chemicals are locked and inaccessible to residents in care. In the kitchen area, a portion of the wall above the faucet and below the glass wood cabinet has exposed drywall. The facility room temperature is 75 degrees Fahrenheit. In the hallway leading to the storage room and perpendicular to the laundry room, there is a water leakage. (Photographs were taken.) In the bathroom between resident rooms 6 and 5, there are exposed wall. The bathroom between resident room 1 and two, S1 stated that there was plumbing issues. AD stated "the drain backed up happened this morning and the maintenance worker is resolving it." Across from the washer and dryer machine, there is a ceiling wall that is damaged. In bedroom #10, LPAs observed a container of Ultra Clean Detergent which the door of bedroom #10 was not locked and the door was open and was accessible to residents in care. S1 removed the detergent during the visit. LPAs observed the bathroom near resident room 15, the wall had stains and the ceiling fan had lint. LPAs observed the fridge perpendicular to resident room #6 had stains and ice buildup and observed food on the ground. See LIC 809C. Page 1 of 3. Pursuant to California Code of Regulations (CCR), Title 22, Division 6, deficiencies are being cited during today's visit based on LPAs observations, please see LIC 809D. The Department is issuing an immediate civil penalty of $250 for each repeat violation for the following deficiencies: 87303 Maintenance and Operation (a) was cited on February 22, 2024. An Exit Interview was conducted with the Administrator Designee which includes the review of this Evaluation Report and a provided copy of this report to the Administrator Designee. Appeal Rights were provided to AD. END OF REPORT. Page 3 of 3. While touring the backyard, LPAs observed directly next to the bedroom 16 exit outside, has a garden tool that is accessible to residents in care. LPAs observed a storage shed next to the gazebo which had a window opened with tools and chemicals when reaching the window. LPAs observed the wood fence being propped to prevent the fence from falling. In the outside premises, the exterior door of Room #12, the screen door is not attached. In the exterior, one of the wood handrails for the ramp for Room #3 is fragile and wiggles when used as support. When entering the second story directly from the outside, LPAs observed in front of staff rooms, chemicals and tools are accessible to residents in care. LPAs randomly tested three (3) resident bathrooms where the water temperature is recorded between 112 to 116 degrees Fahrenheit. In the living room, there were facility activities occurring for the residents such as music performance. Based on a review, the fire department conducted an inspection of for the sprinkler system which was in February 2024. The fire extinguisher was last serviced on January 8, 2025. LPAs reviewed 4 Resident Records and 4 Staff Records. LPAs requested to review R1 to R4’s Appraisals Needs and Services. AD stated, “forms have not been filled out yet.” 3 out of 4 staff records did not have a signed Health Screening form by the Physician. LPAs also reviewed the Centrally Stored Medication and Destruction Record for 4 residents. LPAs reviewed facility disaster drill log, which stated January 25, 2025, was the last drill conducted. Additionally, LPAs audited the First Aid Kit, which has all the tools and equipment necessary for an emergency such as tweezers and scissors. LPAs requested a copy of the updated facility sketch plan. See LIC 809 C. Page 2 of 3.