Routine inspection·May 12, 2025

At approximately 10:40 AM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by Administrator Delia Ulbata. Facility is a Residential Care Facility for the Elderly (RCFE) with ten (10) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for two (2), with one(1) Hospice residents currently in care and is approved for all non-ambulatory residents. At approximately 11:40 AM, LPA initiated a tour of the facility with Administrator and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were last inspected 2/25. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperature measured 113.3 degrees F and 115.5 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. There is a shaded seating area in the backyard with outdoor space for activities. Facility has an internet access device designated for resident use and internet service available. Facility telephone was tested and operational during inspection. LPA observed that that one (1) of two (2) backyard gates was in need of repair with boards of wood falling off when LPA attempted to open it (deficiency cited). Continued 809C... Continued from 809... Facility conducts quarterly disaster drills, and the most recent drill was conducted 2/25. LPA observed facility's infection control plan and emergency disaster plan which was last updated 3/25. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. At approximately 12:45 PM LPA conducted a review of five (5) resident records. All required documentation present. At approximately 1:30 PM LPA conducted review of two (2) staff records. All required documentation present. At approximately 2:00 PM LPA and Administrator conducted a spot check of medication and medication records. Medication is centrally stored and locked. Delia Ubata Administrator Certificate 6035695740 expires 6/23/2025. All fees are current as of this time. Updated copies of the following documents were gathered during this visit : Liability Insurance LIC500 - Personnel Report LIC610E - Emergency Disaster Plan Updated copies of the following documents shall be submitted to CCL within 30 days of this visit : LIC400 - Affidavit Regarding Client Cash Resources LIC308 - Designation of Responsibility 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.