Routine inspection·May 27, 2025

At approximately 12:35 PM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by Caregiver. Facility is a Residential Care Facility for the Elderly (RCFE) with three (3) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for three (3), with one (1) Hospice residents currently in care, and is approved for all non-ambulatory residents. Resident (R1) will be moving out at end of month. Administrator Juliana Clarin (Melegrito) arrived approximately 2:15 PM. At approximately 1:15 PM, LPA initiated a tour of the facility with Caregiver and observed the following: Facility is a two (2) story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were last inspected 9/24. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperatures measured 114.2 and 113.1 degrees F, which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food, as well as an emergency water supply. Food was found to be stored in a safe manner with open items covered. There is a shaded seating area in the backyard with outdoor space for activities. Facility telephone was tested and operational during inspection. The second story is for caregiver use only and stairs are made inaccessible to residents. Continued 809C... Continued from 809... Facility conducts quarterly disaster drills, and the most recent drill was conducted 5/25. LPA observed facility's infection control plan and emergency disaster plan. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. At approximately 2:00 PM LPA conducted a review of two (2) resident records. All required documentation present. At approximately 2:20 PM LPA conducted review of two (2) staff records. LPA observed that Staff 1 (S1) and Staff 2 (S2) were not associated to facility (Deficiency cited). At approximately 2:40 PM LPA and Administrator conducted a spot check of medication and medication records. Medication is centrally stored and locked. Juliana Melegrito Administrator Certificate 7006827740 expires 1/31/2027. All fees are current as of this time. Updated copies of the following documents shall be submitted to CCL within 30 days of this visit : Liability Insurance LIC500 - Personnel Report LIC308 - Designation of Responsibility LIC400 - Affidavit Regarding Client Cash Resources LIC610E - Emergency Disaster Plan Deficiencies are cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, or repeat violations within a 12-month period, may result in a civil penalty assessment. Appeal rights were provided. Exit interview conducted with Administrator, whose signature on form confirms receipt.