Routine inspection·August 8, 2024

On 8/8/2024 at 9:15 a.m. Licensing Program Analysts (LPAs) Marcella Tarin & Maria (Mita) Partoza conducted an unannounced required 1 year Inspection and LPA was greeted by staff upon arrival. Licensee/Administrator, Vicky Ablao arrived shortly thereafter. LPAs stated the purpose of the visit. The facility is an Residential Care Facility serving adults from 60 and over and has hospice wavier for 5, and capacity of 6. At 9:15 a.m. LPAs toured the facility inside and out. Four residents were present and engaged in various activities. The temperature inside the home was at a comfortable 73 degrees F. Residents bedrooms were observed to be sanitary, organized with sufficient storage for resident's personal belongings. LPAs observed working auditory alarm system for each resident's emergency exit doors. Bathrooms were observed to be clean, with grab bars, toilet papers and non-skid mats. Hot water temperature was measured 107.4 degrees F. Living room and activity area, kitchen and dining area were observed to be in order. Cleaning supplies, toxic and sharp objects are secured and inaccessible to residents. 7 days of non-Perishable and 2 days of perishable food supplies were observed. Smoke alarms, carbon monoxide detectors were observed to be in good working condition. The fire extinguishers was last inspected on 3/8/2024. The facility has first aid kit that are accessible to staff. Medications were stored in a locked medication cart. At 10:15 a.m. LPAs discussed with administrator (ADM) maintenance and housekeeping such as changing the bathroom shower liner that was observed to have black residue at the bottom and the cabinet door to the right was loose/coming off the hinge. LPAs observed part of a wooden ramp that has loose planks and loose hand rail posts, which are are not secured to the bottom of the ramp (ramp is located on the exterior of bedroom #1) . LPAs observed missing grout between tiles on the kitchen counter next to the sink where food is prepared, food particles were stuck in between the spaces that could contaminate food served. page 1 of 2 see LIC 809C Staff records were reviewed to be complete and current with CPR/first aid, clearances and training. Residents records, medications are labeled and log on the Centrally Stored Medication & Destruction Record (CSMDR). Emergency drill is conducted on 1/2024, 4/2024 & 7/2024. ADM stated that fire inspection is conducted yearly to assess the fire sprinkler installed in the facility. The sprinklers were tested on 8/28/2023. Deficiencies are cited during today's visit based on California Code of Regulations (CCR) Title 22. See LIC 809D. An exit interview was conducted with ADM Vicky Ablao. A copy of the report and appeals rights were provided. LPAs requested for the following documents and were provided by the administrator. LIC 500, LIC 308, updated copy of administrator certificate and resident roster. A copy of the liability insurance and the lease agreement. End of report, Page 2 of 2.