Routine inspection·January 16, 2025

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced annual inspection and met with Administrator (ADM) Myla Ilagan. LPA toured the interior and exterior of the facility with ADM to include the kitchen, office, resident rooms, dining room, bathrooms, back and front of the facility. The facility is a residential care home for the elderly, and consists of two large buildings, Wing A and Wing B. Facility thermostat temperature display was observed at 68 degrees F. All exit and passageways were free and clear of obstruction. At 9:50 AM LPA toured the Wing B of the facility. LPA observed the facility thermostat temperature display at 68 degrees F. LPA toured 8 resident rooms in Wing B. LPA observed 7 out of 8 resident rooms to have functioning lights, a bed, a dresser/table and storage space for personal belongings. LPA observed 7 out of 8 resident bathrooms had functioning lights, paper towels and hand soap. 7 out of 8 resident bathrooms had no slip-resistant mats on the bathroom floor. At 9:55AM, during tour of resident rooms, LPA observed a male staff member asleep in an unoccupied bedroom (#18). ADM stated the staff member would be leaving and had worked the overnight shift. LPA advised ADM that facility shall be large enough to provide comfortable living accommodations and privacy to staff members who may reside in the facility. At 10:15AM LPA toured the Wing A of the facility. LPA toured 13 resident rooms in Wing A. 13 out of 13 resident rooms had functioning lights, a bed, a dresser/table and storage space for personal belongings. 7 out of 7 resident bathrooms have paper towels, hand soap and functioning lights. LPA measured hot water temperature with a range from 105 to 112.2 degree F in resident bathrooms. See LIC809C At 10:30AM, LPA toured resident room #1 and bathroom #1 (unoccupied), and observed the room was converted to storage space. LPA advised ADM to submit an updated facility sketch to include the converted bedroom #1 and bathroom #1 to storage space. LPA also observed 6 out of 7 resident bathrooms did not have slip-resistant mats on the floor. At 10:45AM LPA toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to clients in care. The facility was equipped with smoke and carbon monoxide detectors. All smoke detectors functioned properly when tested by ADM. Fire extinguishers were last serviced on 10/31/2024. LPA reviewed the facility first aid kit, and it was observed to be complete. The facility emergency drill log was reviewed. The facility's last drill was on 11/24/24. LPA reviewed 8 resident records. 8 out of 8 resident records were found to be complete. Resident records included emergency contact information, physician’s report, appraisal/needs and service plans, and personal rights. During resident record review, LPA observed that R3 and R8's medical assessment's ambulatory status is non-ambulatory. R3 and R8 occupy ambulatory rooms. LPA advised ADM to partner with the families of R3 and R8 to move residents to non-ambulatory rooms. LPA reviewed 8 resident’s Centrally Stored Medication and Destruction Records (CSMDR’s). 8 out of 8 CSMDR’s were observed to be complete with all medication documented. LPAs reviewed 7 staff records. 7 out of 7 staff records were found to be complete. Staff records included fingerprint background clearance, medical assessment with TB result, personnel record and staff training. LPA observed that 5 staff were not associated to the facility, but had obtained fingerprint background clearance. LPA advised ADM to associate staff to the facility by 1/17/2025. Deficiencies were cited during today’s visit per California Code of Regulations Title 22. See LIC809-D. A Technical Violation was also issued. See LIC9102 for more information. An exit interview was conducted with ADM Myla Ilagan. A signed copy of this report and appeal rights were provided.