Routine inspection·June 3, 2024

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Required - 1 Year & Legal/Non-compliance Inspection and met with, assistant Administrator, Renato Yamat . There are currently 5 residents in care, with none of the residents receiving Hospice services. This facility is licensed for a total of 6 residents, with a hospice waiver to allow all 6 residents on Hospice services and no approval for bedridden residents/rooms. LPA toured facility and grounds and observed the facility to be clean and at a comfortable temperature with all exits free from obstruction. This facility is a two story home and all resident bedroom are located in the first level and staff occupy the second level. LPA observed gates at the bottom of both stairs, but the gate in the front room needed to be adjusted. Residents have push button system to alert staff for assistance. Fire Extinguisher was found to be charged and last serviced on January 5, 2024. Smoke detectors and carbon monoxide detectors were tested and found to be operational during the inspection. Water temperature in resident bathrooms measured at 110 degrees and is within acceptable range of 105 to 120 degrees F. There was sufficient perishable and non-perishable foods located in the kitchen and garage and food is stored properly. Medications were centrally stored and locked. Cleaning products and other toxins are locked and inaccessible to residents in care. There was a supply of Linens, hygiene products and paper products available for residents. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats. A tour of all resident bedrooms was conducted, and bedrooms inspected have lighting and appropriate furnishing. Administrator certificate for Michelle Jangar #6008305740 expires 10/25/2025. Staff have the required training and proof of CRP/1St Aid. Resident files were reviewed. Continue report see LIC809-C Assistant Administrator and LPA discussed their Emergency Disaster Plan and Infection Control Plan. LPA went over Legal/Non-compliance plan and reminded Facility agreed to provide quarterly financial documents for the month February/March/April 2024 by May 17, 2024. Facility agreed to ensure proper bookkeeping and having adequate Finance staff and not commingle funds between all five (5) licensed facilities. Facility to ensure food costs are related to the resident census per facility. Licensee/Administrator to submit the current following documents by 6/29/2024: · LIC 308 Designation of Facility Responsibility · LIC 500 Personnel Report · LIC 400 Affidavit Regarding Client/Resident Cash Resources · LIC 610E Emergency Disaster Plan · LIC 9020 Register of Facility Residents Infection Control Plan of Operation (If changes) Liability Insurance Copy of current Lease Agreement No citations issued during this visit.