Routine inspection·April 8, 2025

On 4/8/2025 Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced required 1 year inspection. LPA met with Debbie Aguilar LIC/ADM. LPA stated the purpose of the visit. The facility has a current census of 6 residents and serves 60 and over who are elderly and has neurocognitive disorder. 5 may be non-ambulatory and 1 may be bedridden. LPA observed 2 staff at the time of the visit. All residents are present during the time of the visit 6 out of 6 were in their room and resting, 3 out of 6 are non-ambulatory, 1 out of 6 is ambulatory and 2 out of 6 is bedridden. LPA toured the facility inside and outside including the living room, kitchen, dining room, 2 restrooms, 5 resident bedrooms and staff room, backyard and side emergency exits. LPA observed hallways and walkways to be free from obstructions. LPA observed the kitchen, dining, resident bedrooms, and staff room be organized and sanitary, the restrooms are equipped with anti skid mat and grab bars. Residents room has ample storage for their personal belongings. LPA inspected food storage and observed 2 days of perishable and 7 days of nonperishable food supplies. LPA observed the medication, chemicals and knives were locked and not easily accessible to residents. The room temperature is at 70 degrees F, and hot water temperature was measured at 105 degrees F. Fire extinguisher was last inspected on 7/9/2024. The facility is equipped with carbon monoxide and smoke detectors and were observed to be in good working condition when tested. page 1 of 2 See LIC 809C ADM stated that 2 residents are bedridden. LPA discussed with ADM that per fire clearance the facility cannot have more than 1 bedridden resident. LPA observed 2 staff (S1, S2). S2 have been separated from the facility since on 10/4/2019. ADM submitted a list of Personnel to Community Care Licensing Division (CCLD) on 1/23/2025 and S2 is not listed as a staff. S2 stated that he/she has been an staff for more than 5 years, left the facility when S2s spouse passed away and came back. S2 has clear criminal background on record and have not worked in any other facility. ADM stated S2s spouse passed away and was the one being removed from the record and not S2. ADM associated S2 by submitting the application to Guardian but can no longer be associated due to the fact that S2 has been separated from the facility for more than 5 years. LPA observed facility first aid kit were complete and were accessible to staff. LPA reviewed 3 out of 6 resident record and 2 staff record and found them to be complete and up to date. Disaster training was administered on 3/1/2025 (fire, disaster & earthquake). Staff training was up to date and complete. Based on observation and document review, the following deficiencies are cited today based on the California Code of Regulations (CCR) Title 22, 87202(a)(2) for the fire clearance and 87355(e)(2) for S2s criminal background clearance that is no longer valid after 3 years and will require a new livescan. Violation of Section 87355(e) shall result in an immediate assessment of civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days by the department a total of $500.00. An exit interview was conducted with LIC/Administrator Debbie Aguilar. A copy of the report and appeals rights were provided. page 2 of 2 end of report