Routine inspection·October 21, 2023

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with staff member Melanie Ablan , (S1). (LPA observed 3 staff on duty during visit, including staff member S1) LPA toured the facility inside out with S1 which included; the Living room, kitchen, dinning room, two restrooms and 5 residents bedrooms. The staff area of the facility was also inspected. Front yard and backyard were inspected. There was no obstruction to block the walkways. While touring resident bedrooms, LPA observed Senna & Tums medication in resident bedroom #4's bathroom sink cabinet. (Photographs were taken.). S1 stated resident R1's has been stubborn. S1 stated R1 will ask family to bring him/her medication and R1 will hide medication in his/her room. R1's physicians report,dated June 13, 2023, states that R1 cannot administer his/her own medications. R1's physician report also states R1 is not able to store his/her own medications and is "unable to differentiate medications." Wile touring the backyard, LPA observed detergent and fabric softener next the facility washing machine. (Photographs were taken.) Resident R2 was sitting in the family room, approximately 5 feet away from the sliding door, which is directly next to the laundry area. S1 stated resident R1 also goes to the backyard on some occasions. Two day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication closet, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 75 degree F, and hot water temperature was measured to range from 108 to 110 degrees F in both resident bathrooms. Page 1 out of 2 Fire extinguisher was serviced in May 2023. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by S1, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on September 16, 2023. LPA reviewed facility records for 2 staff & 2 residents. LPA reviewed 2 resident medications and centrally stored medication records. LPA conducted interviews with 2 staff (S1 to S2) and 2 residents (R1-R2). A deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. Exit interview was conducted with Administrator Ryan Ablan, and staff member Melanie Ablan signed on his behalf . Appeal rights were provided. Page 2 out of 2