Routine inspection·March 30, 2023

Licensing Program Analysts (LPAs) Simi Rai and Manuel Monter conducted an unannounced Required 1 Year visit and met with Licensee Eliza Daquioag. During visit, LPAs toured the inside and outside of the facility. LPAs toured the facility kitchen and observed food supply of at least 2 days of perishable food supply of at least 7 days of nonperishable food supply. Sharps and medications were locked in secured areas. There was a first aid kit in the facility. LPAs observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. The facility bathroom had available soap, paper towels,and trash cans with lids. The shower had grab bars, non-skid mats, and a shower chair. The water temperature in the bathroom sinks ranged from 113.3F - 116.4F. The water temperature in the showers ranged from 105.8F-117.6F. The water temperature in the kitchen sink was 117.1F. Two fire extinguishers were observed and both were inspected on January 2023. Facility smoke detectors were tested and found to be functioning when tested. Five out of five resident bedrooms had available bedding, drawers, and functioning lights. During tour of the resident's rooms, LPAs observed residents R1-R5 having half bed-rails or grab bars attached to the resident's bed. Licensee stated the residents use the bed-rails or grab bars for mobility. LPAs reviewed resident records for R1-R5, a physician's order was not obtained for the half-bed rails or grab bars. Per Licensee, the residents are not under the care of a Hospice agency. Licensee stated they will obtain physician's order for the half-side rails and grab bars which are attached to the resident's bed. See LIC809-C for more information. Page 1 of 2. When touring the outside area of the facility, the exits were cleared of obstruction. LPAs observed a gas stove outside of the kitchen area. Per Licensee, the stove was installed 6 months ago and the purpose of the stove is to deep fry food items. Licensee stated they will remove the stove and propane tank. Licensee stated they will provide a picture of the area once the stove is removed to LPA Monter. LPAs inspected the storage areas outside of the facility and the storage units contained tools, cleaning products and no sign of area being used as a living quarter. LPAs reviewed facility records for staff and residents. LPAs reviewed resident medications and central stored medication records. LPAs conducted interviews with 2 residents (R1-R2) and 1 staff (S1). Advisory Notes and Technical Violation were issued. See LIC9102 pages for more information. Deficiencies were cited from California Code of Regulations, Title 22 during today’s visit, see LIC 809-D. This report was reviewed with Licensee Eliza Daquioag and a copy of the report was provided. Appeal Rights were provided.