Routine inspection·April 29, 2025

Licensing Program Analysts (LPAs) Christi Coppo and Ethel Contreras arrived unannounced to conduct a required Annual inspection and was greeted by Administrator Gideon Castro. Facility contact information was reviewed. At approximately 10:00am LPA and Admin toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered. Kitchen cabinet containing cleaning supplies was locked. Kitchen drawer with sharp knives locked. All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Resident bathroom did not have required bath ma t(Technical). Restrooms did have required grab bar. Facility has two water heaters. Water temperature in sink accessible to residents in care measured at 116.6 degrees F which is within the allowable range of 105 to 120 degrees F. Restroom in room six water measured at 99.01 which is not within the allowable range of 105 to 120 degrees F. Bedroom five had oxygen tanks in which 1 out of 3 were not placed in holder and not strapped to the wall (Technical). LPAs observed Thick-It thickener stored under stairs made accessible to residents. Thickener prescribed to resident's name that does not match any current residents. Medication fridge unlocked, making medication accessible to residents. Fridge had suppositories (Bisacodyl 10mg) with resident's name that does not match any current residents. Insulin pen without a label inside ziplock bag in also in fridge . (Deficiency cited, see 809D). Medications found to be pre-poured in small plastic containers inside kitchen drawer on left hand side of refrigerator and not in its originally received container. (Deficiency cited, see 809D) Continued on 809C... Continued from 809... Tiles on vanity in bathroom next to room #4 and around left hand side of kitchen sink observed to have dark black substance present in grout as well as broken tile. Deck ramp on wrap around deck has two sections of plywood. Section of plywood in the middle of ramp bows heavily under pressure, cracking sound when stepped on. (Deficiency cited, see 809D). Fire extinguishers were last inspected 4/1/25. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drills were conducted with each staff member during their respective training days, LPA observed all training dates for respective staff were within the quarter. Facility has a backup generator for use during a power outage. LPA conducted a review of 4 resident records. All required documentation present. 1/2 rails and crushed meds orders all on file for respective residents. LPA conducted review of 3 staff records. Health Screening for all staff appeared fabricated. Health Screenings had same exact hand writing and date of visits listed within 3 days of each other. Furthermore, signature of physician appeared to be he same on all screens and lacked date. Additionally, TB test marked as negative but action taken listed as chest X-ray. LPAs discussed appearance of fabrication with admin. Admin denies fabrication. Admin agrees to submit current health screenings with TB clearance to CCL. Three out of three staff had expired first aid expiring on 1/06/2025. Additionally, LPAs attempted verification of first aid certificate numbers via American Red Cross website, unable to locate certificate. (Deficiency cited, see 809D). Continued on 809C(2).... Continued on from 809-C... LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked closet. LPAs advised admin to complete prescribing physician;on Centrally Stored Medication Log. Gideon Castro Administrator Certificate #7004971740 expires 5/19/2026. All fees are current as of this time. LPA and Administrator discussed facility's Infection Control Plan and Emergency Disaster plan. No new updates. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility Liability Insurance Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator and a copy of this report was given . LPAs experienced printer issues and was unable to final print, time of completion 3:50pm. LPAs will email copy of report and deficencies.