Routine inspection·August 11, 2025

Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to conduct the facility's required - 1 year annual inspection. Administrator, Syeda Haroon was contacted but was unavailable during time of visit. LPA met with designated Administrator, Dulce Rose Cera During visit, LPA toured the facility to include 5 resident bedrooms, 2 bathrooms, living room, kitchen, dining room, laundry room, garage, backyard and exterior. All emergency exit routes were free and clear of obstruction. The front door and backyard door observed with operable door alarms. There was 2 staff present to 6 residents. Both staff are fingerprint cleared and associated to the facility. Facility temperature maintained at 77 degrees F. Fire extinguisher last serviced on 06/17/2025. Carbon monoxide detector present and observed operable. Facility has at least 2 days worth of perishables. LPA observed only 24 cans of non-perishable foods in the facility for 6 residents. LPA observed additional items of non-perishable foods to include 3 packages of crackers, 1 pack of cookies, 1.5 packs of apple sauce, and container for cereal. Facility was provided a technical advisory on Title 22 regulation Section 87555 - General Food Service Requirements advising that the facility shall maintain minimum of 7 days worth of nonperishable foods at all times. Refrigerator temperature maintained at 37 degrees F. Freezer temperature maintained at -2 degrees F. Items inside the refrigerator observed covered and labeled. Page 1 of 3. The chemicals, disinfectants, and toxins are stored separately from the food supply. The drawer and cabinet containing sharp objects, chemicals, and disinfectants observed closed with a lock but LPA observed the drawer and cabinets were unlocked upon opening. All resident's are non-ambulatory and require staff assistance when ambulating. During visit, facility staff locked the cabinets and drawers that contains sharps and toxins. Facility was provided a technical advisory on Title 22 regulation on Section 87309(a) - Storage Space and Access. Designated Administrator stated understanding. Resident bedrooms equipped with beds, linens, dressers, night stand, and adequate lighting. Bathroom equipped with grab bars in the shower and next to the toilet and non-slip mats in the shower. Hygiene products and paper supplies observed. Bathroom hot water temperature in the hallway and master bedroom was measured. The hallway hot water temperature measured at 135.6 degrees F and the master bedroom hot water temperature maintained at 136.5 degrees F. A type A deficiency is being cited today in violation of Title 22 Section 87303 - Maintenance and Operation for the hot water temperature exceeding 120 degrees F. There are 2 residents under hospice care. Bedroom #2, #3, and #4 equipped with full bed rails in which 1 out of 3 residents are under hospice care and the physician's order for full rails is listed in the hospice care plan. 2 out of the 3 resident's (R1 & R2) is not under hospice care but utilizes full bed rails. Based on review of the facility file, the facility did not request for an exception for the use of full bed rails nor did the facility obtain a physician's order for the full rails. Facility was advised. A type A deficiency is being cited today in violation of Title 22 Section 87608 - Postural Supports wherein 2 residents who are not receiving hospice care is utilizing full length bed rails which are prohibited unless granted approval from the Department. 4 resident files were reviewed. 3 out of 4 resident files were observed complete and up-to-date. 1 out of the 4 resident's (R1) file did not contain a medical assessment prior to admission. A type B deficiency is being cited today in violation of Title 22 Section 87458 - Medical Assessment wherein the facility did not obtain a physician's report prior to admitting R1. Page 2 of 3. 3 out of 4 residents centrally stored medications and centrally stored medication records (CSMR) were reviewed and issues were noted for resident R2 - R4. There was 2 medications not written in the CSMR for R2, 6 medications not written in the CSMR for R3, and 2 medications not written in the CSMR for R4. A type B deficiency is being cited today in violation of Title 22 Section 87506(a) - Resident Records wherein 3 residents (R2 - R4) centrally stored medications were not maintained as there was a total of 10 medications that were not written in the CSMR. 3 staff files were reviewed and observed complete to include an active first aid certification, fingerprint clearance, health screening, TB result, and annual training per Title 22 regulations. Facility has an emergency disaster plan and LPA advised Administrator to update the emergency disaster plan annually. Facility has emergency lighting available when needed. First aid kit observed. Based on record review, the emergency drills were completed in 2024 but during visit, there was no record to show the emergency drills were completed for this year. The last drill completed and recorded was for December 2024. A type B deficiency is being cited today in violation of Title 22 HCS 1569.695(c) as the facility has not completed quarterly emergency drills as required. Deficiencies were cited per California Code of Regulations, Title 22. See LIC809-D. Advisory note also provided. This report was reviewed with designated Administrator, Dulce Rose Cera and a copy of the report and appeal rights were provided. Page 3 of 3.