Routine inspection·May 30, 2025

On 05/30/2025 at approximately 09:30AM, Licensing Program Analyst (LPA) Ali Deniz arrived unannounced to conduct 1-Year Required visit of this licensed Residential Care Facility for The Elderly (RCFE). LPA was greeted by Staff, Christian Morales Cervantes. Licensee/Administrator, Emmanuel Salas arrived during visit at approximately 09:50AM. Facility has an approved fire clearance and capacity for 6 non-ambulatory residents and has an approved hospice waiver for 2 individuals. Upon arrival, LPA was informed that there were 5 residents in care and 1 staff member on-site. Facility is a 1 story building with 4 Resident bedrooms, 1 staff bedroom, 2 bathrooms, and common spaces. At approximately 10:05 AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 10:15AM, LPA toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted. The garbage bins in the resident room did not have proper cover or lid. Licensee agrees to get lid or cover for the garbage bins in the resident room (Technical Advice given). LPA observed activity supplies for resident use. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Toxins are stored in a locked kitchen cabinets under the sink and cabinets in the laundry room. Water temperature measured 109.6 degrees F and 107.4 which is within regulation between 105- and 120-degrees F at faucets accessible to residents. Fire extinguishers were bought new on 05/20/2025. Carbon Monoxide detectors were present and in order. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure. Continued on LIC809C... Continued from LIC809... At approximately 11:10AM, LPA reviewed 3 resident records and found 3 out of 3 residents did have current physician's reports, care plans, signed admission agreements, and physician's orders on file. Medication records are thorough and contained physician's orders for each resident. At approximately 12:05PM, LPA reviewed 3 staff records. 3 of 3 records did contain documentation of completed training records as required. Evidence of first aid and CPR training were current and/or renewed at the time of the visit. At approximately 12:50PM, LPA reviewed the facility emergency disaster plan with Licensee. The plan outlines evacuation routes, which are shown on facility sketch and has alternative meeting locations. Facility has supplies enough to operate for more than 72 hours in an emergency. Facility conducted and documented a disaster drill on 02/04/2025. Licensee/Administrator stated that they forgot to get it done and will complete on 05/31/2025(See LIC809D page). LPA was presented with proof of current CPR & 1 st Aid certification for staff. Administrator Certificate is for Emmanuel Salas #7010884740 expires on 10/08/2025. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 10 days of this visit: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Resident’s Copy of Updated Certificate of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809D, Plan of Corrections, and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.