Routine inspection·March 26, 2025

Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to conduct the facility's required - 1 year annual inspection. LPA met with Administrator (ADM), Michelle Pagkalinawan. During visit, LPA toured the facility with ADM to include all the resident bedrooms, 3 bathrooms, hallways, kitchen, dining room, living room, garage, shed and exterior. The shed contains storage items. The facility currently has 6 out of 6 hospice care residents. 4 facility staff present are fingerprint cleared and associated to the facility. Facility temperature maintained at 75 degrees F. The stairways, ramps, and hand railings observed sturdy and in good repair. Fire exit routes are free and clear of obstruction. LPA observed the exit door next to the laundry machines and front door contains a door alarm that was not functioning. ADM has a plan to replace the batteries for the door alarms. Fire extinguisher last serviced on 09/16/2024. There are 2 operable carbon monoxide detectors in each wing of the facility. Resident bedrooms equipped with beds, linens, dressers, night stands and adequate lighting. Bathrooms equipped with soap, paper supplies, and hand washing signs. The bathtub contains a non-slip mat. The bathroom hot water temperature next to room #5 was initially measured at 133 degrees F and the hot water temperature next to room #7 was measured at 117 degrees F. Both bathrooms share the same hot water furnace. During visit, the ADM turned down the hot water temperature. LPA measured the bathroom hot water temperature next to room #5 and #7 maintained at 117 degrees F. See LIC809C. Bathroom hot water temperature next to room #3 uses a separate hot water furnace, which was initially maintained at 114.8 degrees F. Facility has at least 2 days worth of perishables and 7 days worth of non-perishable foods. LPA observed the drawer that stores sharp objects was not locked in the kitchen area. Based on observation and interview, the lock for the drawer was broken. LPA also observed the cabinet that stores resident medications was not locked in the kitchen area. Based on observation and interview, the lock for the cabinet was broken. ADM and staff state that they close the kitchen door during the evening, however, the kitchen door does not lock. Staff immediately fixed the locks for the sharp objects and medications. During visit, LPA observed the sharp objects and medications were secured and locked. Facility has emergency lighting and flashlights. Facility has an emergency disaster plan. Disaster drills are completed quarterly and the last drill completed on 02/2025. 4 resident files were reviewed. 2 out of 4 resident's file did not contain an up-to-date needs and services plan, as they were dated in 2022 and 2023. LPA observed the facility documents the residents change of condition, however, the information was not being transferred onto the needs and services plan. 4 out of 4 resident files were completed to include an admission agreement, physician's report, TB result, consent form, personal rights, and safeguard of personal properties and valuables form. 4 out of 4 residents medications and centrally stored medication records were inspected with all medications accounted for. 4 staff files were reviewed. 4 out of 4 staff files were observed complete to include fingerprint clearance, health screening, TB result, and annual training records. ADM was reminded to pay their licensing fee that is currently due. Deficiencies were cited per California Code of Regulations, Title 22. See LIC809-D. Advisory note provided. This report was reviewed with Administrator (ADM), Michelle Pagkalinawan and a copy of the report and appeal rights were provided.