Routine inspection·July 10, 2025

On 07/10/2025 at approximately 09:45AM, Licensing Program Analyst (LPA) Ali Deniz arrived unannounced to conduct 1-Year Required visit of this licensed Residential Care Facility For Elderly (RCFE). LPA was greeted by Administrator, Dinah Belandres. The facility currently provides care for 6 clients. Facility has an approved fire clearance for 6 non-ambulatory residents. Upon arrival, LPA was informed that there were 3 staff members on-site. The facility is a single-story building with 8 Resident bedrooms (one of the bedrooms used as an office, another bedroom used as a staff room), 4 bathrooms, and common spaces. At approximately 10:15AM, 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 11:05AM, LPA and Administrator toured the building and grounds which were 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 and are in a highly visible area. LPA observed outdoor area chairs and tables are not safe for residents’ use. License agrees to buy new chairs and table for outdoor sitting area. The amount of fresh and nonperishable foods is within regulation. The facility kitchen, refrigerators and freezers were clean, and food was stored properly. Toxins are stored in the laundry room. Water temperature measured 110.6 degrees F degrees which is within regulation between 105- and 120-degrees F at faucets accessible to residents. The facility has emergency lightning if need it. Fire Extinguishers found to be last charged on 07/10/2024 at the time of visit. Carbon Monoxide and smoke detectors were present and in order. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure in a cabinet in the kitchen. Continued on LIC809-C… Continued from LIC809… At approximately 12:05PM, LPA reviewed 3 resident records and found 3 of 3 residents have current care plans, signed admission agreements, and physician's report on file. Medication records are thorough and contain physician's orders for each resident. At approximately 12:25PM, LPA reviewed 2 staff records. 2 of the 2 records did contain documentation of completed training records as required. However, S1’s TB test results were not present on file. Administrator agrees to share TB results(Chest X-Ray) with CCL for S1 before 07/11/2025(Technical Advice Given). Evidence of current first aid and CPR training was current. LPA was presented with proof of current CPR & 1 Aid certification for the whole staff. Administrator Certificate is for Dinah Belandres #7032809750 on renewal process and renewal application submitted on 04/25/2025. LPA reviewed the facility emergency disaster plan. Facility has supplies enough to operate for more than 72 hours in an emergency. Facility conducted and documented a disaster drill on 07/02/2025. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by due date of 07/20/2025: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (If changed) LIC 9020 Register of Facility Client’s/Resident’s Copy/Proof of Updated Certificate of Liability Insurance No deficiencies were observed in the areas inspected, No citations were issued during today’s visit. Exit interview conducted. Copy of report provided to Administrator. Signature on form confirms receipt of documents.