Routine inspection·March 25, 2024

On 3/25/2024 Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced Annual required inspection at facility and met with caregivers/designated administrators Joselito Garcia (S1) and Nancy Esteban (S2). Administrator (ADM) Debbie Aguilar is currently out of the country at the time of this visit. LPA accompanied by S1 toured the exterior, and interior of the facility including, but not limited to the following areas, 5 resident bedroom, and 1 staff room, 2 bathrooms, the kitchen, dining, living room and activity area. The facility's room temperature was 73 degree F. LPA inspected the exterior and walkways and pathways were free from obstruction. LPA inspected the kitchen observed, knives were safe and secure in a locked cabinet. LPA inspected the refrigerator and freezer, and observed 2 days' supply of perishable foods, an the pantry has 7 days supply of nonperishable food. LPA observed chemicals, laundry detergents and cleaning supplies are in a separate area and not accessible, water temperature in the kitchen sink is at 105 degree F. LPA observed both staff are attending to the residents' needs, after breakfast, the bedrooms and bathrooms were inspected, all residents' bedrooms were observed free of odor. Beds have pillows, top and bottom sheets, waterproof protectors and blankets. Working light fixtures were observed in all rooms. Bathrooms are equipped with non-slip mats, safety grab bars and shower chairs. Hot water temperature was 105 degree F. page 1 continued to page 2 LIC 809C The facility has a wired fire alarm and also has a carbon monoxide detector and a fire extinguisher was last inspected on 05/10/2023. LPA randomly selected 3 resident file record for review and observed 3 out of 3 centrally stored medication record (CSM) are up to date. 3 out of 3 residents have current Appraisal/Needs and Services Plans (ANS) on file. A copy of their Admission Agreement and Personal Rights were also on file. 3 out of 3 residents are missing the Consent Forms, and Weight Record, 1 out of 3 resident file record does not have TB test result documented. S1 and S2 stated, they are both new in the facility and have been working for less than 6 months and is not aware of where the other records are filed. S1 has been in the facility for 4 months, and S2 has been in the facility for 1 month. LPA reviewed facility record and found that the facility disaster preparedness training is up to date. All staff have criminal background clearance from Community Care Licensing and are listed in the facility's personnel roster. Current first aid certification and training for types of residents served were verified. During today's visit, a citation is issued per California Code of Regulation, Title 22. An exit interview was conducted with S1 Joselito Garcia, and S2 Nancy Esteban, the designated ADM for the facility in the absence of administrtor Debbie Aguilar. A copy of the signed report and appeals rights was provided. End of Report page 2 of 2