Routine inspection·July 2, 2024

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Maylene Manalo. During visit, LPA Marrufo toured the facility inside and out. LPA Marrufo observed the kitchen area and observed there to be a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed the locked storage areas for medications, sharp objects, and cleaning supplies. The first aid kit was observed and found to be complete. LPA toured 5 out of 5 resident bedrooms and observed each bedroom to have working lights and available bedding and clothing storage areas. LPA Marrufo tested the smoke detectors in the living room, hallway, and 5 out of 5 resident rooms. A smoke detector in one of the bedrooms had a very faint sound. The smoke detector in the living room had a constant chirping sound during visit. The rest of the smoke detectors functioned properly when tested. LPA Marrufo tested one out of one carbon monoxide detector and it functioned properly when tested. LPA toured the outside area and found the outdoor exit to be clear of obstructions. LPA Marrufo reviewed 4 out of 4 resident Centrally Stored Medication and Destruction Records (CSMDR). One resident does not take medications. Resident R1 was missing 3 medications in the CSMDR and resident R2 was missing 2 medications in the CSMDR. LPA reviewed 5 out of 5 resident records. Resident R1 was missing an Appraisal/Needs and Services Plan. R2's record was missing an Appraisal/Needs and Safeguard for Property and Valuables (SPV) form. Resident R3 was missing an Emergency Contact and Information Form, Appraisal/Needs and Services Plan, SPV, and LIC613C Personal Rights form. LPA Marrufo reviewed 2 out of 2 staff records and found them to be complete. Advisory Notes were issued. See LIC9102 for more information. Deficiencies were cited as per California Code of Regulations Title 22. See LIC809-D page for more information. This report was reviewed with Maylene Manalo and a copy of this report and appeal rights were provided.