Routine inspection·March 27, 2025

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit. LPA Rai met with Administrator, Dina Domingo & Carmen Buno and stated the purpose of today's visit. LPA Rai observed 2 staff who have obtained a Criminal Record Clearance. LPA Rai observed 2 residents at the facility, 1 resident at the day program and 1 resident at the hospital. During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai observed 2 sheds in the backyard which was locked and used for storage and not habitual space. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. LPA Rai toured the facility to include 6 resident rooms, 1 staff room, living room, dining room, kitchen and garage. 6 Out of 6 resident bedrooms had available bedding, drawers, and functioning lights. LPA Rai observed resident R1's room and exit door located in the room. Administrator (ADM) Dina Domingo removed a pole from the top of the screen door which restricted resident from using the exit door. ADM stated R1 exhibited exit seeking behaviors. LPA Rai observed a working door alarm on the exit and the door had locking capabilities. LPA Rai observe safety covers on 2 exit door knobs which hindered the residents from opening the door. ADM removed the child safety covers on the doors. Continuation on LIC 809-C, Page 1 of 2. Page 2 of 2. The facility bathroom had available soap, paper towels, and trash cans with lids. The hot water temperature in the bathroom and kitchen sink ranged from 117.6 - 118.1 degrees F. Fire extinguisher was observed and inspected on 01/21/2025. Facility smoke detectors and carbon monoxide detectors were in working condition. Facility staff had disaster drills conducted on 01/03/2025 & 01/08/2025.  LPA Rai observed a complete first aid kit at the facility. LPA Rai reviewed facility records for 2 staff and 2 residents. LPA Rai observed 1 out of 2 admission agreements were not signed by resident and/or resident's responsible party. LPA Rai reviewed resident medications and central stored medication records. LPA Rai observed resident R1's 4 out of 7 medications were not recorded on the Centrally Stored Medication Log. Per Staff S1, R1 has been administered the medication and LPA Rai observed tablets were taken from the bottle. Deficiencies were cited per California Code of Regulations, Title 22, please see LIC 809-D. This report was reviewed with Administrator, Dina Domingo and a copy of the report was provided. LIC 858 and LIC 859 were provided. Appeal Rights were provided.