Routine inspection·January 7, 2025

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with House Manager (HM) Virginia Quezada . LPA reviewed 2 resident files and 2 staff files. 1 Out of 2 resident files was observed centrally stored medication form does not match with medications. LPA toured the facility inside and out with HM. LPA observed 2 residents and 3 staff in the facility. License, personal rights posters and Administrator Certificate were observed in the facility. LPA inspected living room, family room, dinning room, kitchen. There are 2 restrooms for residents, a restroom for staff, 2 resident shared rooms, 2 resident single rooms, and 1 staff live-in room in facility. Two days perishable foods and seven nonperishable foods were observed sufficient. Room temperature was observed at 73 degree F, hot water temperature was observed at 110 degree F. The facility has 2 refrigerators. HM stated the facility already ordered a new refrigerator to replace one of the existing refrigerators which will be delivered on 1/17/2025. The temperature of the other refrigerator was observed at 36 degree F, and the temperature of the other freezer was observed at 0 degree F. Medication cabinet, Knife closet, and cleaning products closet were observed locked. Fire extinguisher was serviced on 5/28/2024. The facility was equipped with fire/smoke alarm and carbon monoxide detectors. Carbon monoxide detector was tested, and was working fine. The facility is equipped with emergency light system and back up battery system. The facility has bed alarm detector for resident. It was tested by HM, and was observed working. The facility has call alarm system. It was tested by HM and was observed working. Continue on LIC809-C. First Aid box, flash light and night lights were observed in the facility. The last time the facility conducted the emergency drill was on 8/15/2024. HM stated the facility will start to conduct emergency drill every 3 months in 2025. Front yard and backyard were inspected. There were two gates at back yard to go outside. There was no obstruction to block the walkway to one gate. The walkway to the other gate is fine to walk through, but needs to trim the branches of the nearby tree. HM stated the facility will trim it in this week. . Deficiency noted today. See LIC809-D. This report was provided to HM for signature. A copy of this report was emailed to HM.