Routine inspection·October 28, 2024

Licensing Program Analyst (LPA) Maria (Mita) Partoza a conducted an unannounced required 1 year inspection visit and was greeted by the staff Amelia Obra. The licensee/administrator (LIC/ADM) Thelma Llanes was not present at the time of the visit. Per staff, ADM was in attending an in-service training at the hospital where she works as an on-call staff. ADM arrive at the facility at 5:20 p.m. The facility is licensed to serve adults 60 and over, approved for 6 non-ambulatory and waiver for 2 hospice and 1 bedridden allowed. LPA observed 4 residents present at the facility that have neurocognitive disorder, 1 staff (S1) present and the owner's spouse (S2) who has been in the facility since 7/16/2024 after retirement and does not have a criminal record clearance on record. S2 stated that he helps cleans, cook and maintain the facility. S2 stated he/she does not give direct care to the residents. At 3:35 p.m. LPA toured the facility inside and outside with S1 including but not limited to the kitchen, bathroom, dining room, living room, 4 residents rooms, garage, staff room, backyard and exterior walkways. The facility is maintained, sanitary and organized. The bathroom/s are equipped with grab bars, non-skid mats. The water temperature in the bathroom measured between 128.6 degree Fahrenheit. Resident's room have sufficient storage. The temperature inside the home was at 73 degrees Fahrenheit. The kitchen was observed to be sanitary and organized, knives and sharps were locked and not accessible to residents. LPA observed 2 days of perishable food and 7 days of non-perishable food. The kitchen water temperature measured at 128.8 degrees Fahrenheit. page 1 of 2, see LIC 809C LPA observed that medications are kept locked and inaccessible to residents. The first aid kit is complete and is accessible to staff. The backyard, walkways, ramps and patio are free from debris and obstruction. The facility screen windows were observed to be in good repair. The washer and dryer is located in the garage and is in good working condition. Laundry soap and cleaning supplies are locked and not accessible to residents in care. The facility is equipped with a fire, smoke and carbon monoxide alert system, night lights on the hallway are in good working condition. The hallway are free from obstruction. LPA observed 3 surveillance cameras inside the facility on the hallway and kitchen. The video is not recording and there is no audio. LPA reviewed 2 resident records such as but not limited to the centrally stored medication and destruction record (CSMDR), admission agreement, needs and services plan, health screening. LPA reviewed 1 staff records including but not limited to required training, first aid/CPR training, health screening and background clearance. Staff have criminal record clearance/fingerprints. LPA gave technical advisory to ADM for records keeping and maintenance of information and warning signs for taps delivering water at 125 degree Fahrenheit and above. ADM stated that he/she has the documents and will complete the files of each resident and staff. Deficiencies were cited during today's visit based on California Code of Regulation (CCR) Title 22 87355 (e) and 87303 (e)(2), see LIC 809D. An exit interview was conducted with administrator Thelma Llanes. A copy of the report and appeals rights were provided. page 2 of 2 end of report