Routine inspection·July 9, 2025

At approximately 9:45 AM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to conduct a required 1-Year Visit and Non-Compliance (NCC) quarterly visit and was greeted by caregivers Ronald Lazaro and Laila Lazaro. In addition, a private caregiver that a family member had hired to support a resident was present from the ABBA agency. Although not required, it was recommended that this private caregiver be associated to the facility if long term care continues. Imelda Padama, Licensee was contacted via phone and arrived at approximately 10:30 AM. LPA was informed there are four (4) residents in care and all were present during inspection. Facility is a Residential Care Facility for the Elderly (RCFE) with a Hospice waiver for two (2), an approved dementia plan, and fire clearance for capacity of six (6) residents; five (5) non-ambulatory and one (1) bedridden resident in room #4 only. At approximately 10:35 AM, LPA initiated a tour of the facility and observed the following: Facility is a one story home, was a comfortable temperature, free from odors and passageways were free from obstructions. Water temperature in clients' bathrooms measured were above the required range of 105 to 120 degrees F per Title 22 regulations, and licensee had prominent signs warning of the hotter than normal water per regulation. A technical advisory was given to reduce the water temperature to reduce the risk or scalding injuries and licensee turned down the water heater while I was in the facility. LPA observed client showers with grab bars an non-slip mats as required. LPA observed a supply of clean linens, incontinent care products, and paper products available to clients. Clients' bedrooms were inspected and observed to have appropriate furnishings as outlined in Title 22 regulations. Cabinets in communal areas of the facility containing cleaning supplies and other items that could pose a risk were observed locked. Continued on LIC809C Continued from LIC809 LPA observed toxic chemicals under the sink of bedroom number six (6) and Licensee immediately removed and secured the items making them inaccessible to residents in care. Three (3) of four (4) residents rooms, residents R1, R2 and R3 were noted to have a combination of unsecured prescription and non-prescription medicines and a type A deficiency was cited. In addition, it was noted that one (1) of 4 residents (R1) had over-the-counter (OTC) medicines in their room despite their LIC602 indicating the inability to manage or store their own meds and a Technical Violation (TV) was issued. LPA noted that facility has at least two days of perishable foods and one week of non-perishable foods. Medications were centrally stored and locked. There is outdoor space for activities. A locked shed was noted to have extra supplies. LPA observed an activity schedule and games available for resident use. Facility has two fire extinguishers, which were last inspected July 2025 and are fully charged. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Facility conducts disaster drills every three (3) months, and the most recent drill was conducted July 2025. LPA observed the facility's infection control plan, first aid kit, PPE, other emergency supplies, and a back-up generator. LPA noted emergency water supply present as required per regulation. At approximately 11:30 AM, five (5) staff files and four (4) resident files were reviewed. All staff files reviewed had the required CPR and First Aid training certificates, as well as documentation of health and TB clearance and training hours. One (1) of five (5) staff files were not maintained at the facility and needed to be brought over from their sister facility and a technical violation was issued. At approximately 12:30 PM LPA observed one (1) of four (4) resident files missing a pre-placement appraisal, appraisal service and needs plan, signed personal rights, or consent for emergency medical treatment and licensee set out to have items signed by resident that could sign for themselves and a technical violation was issued. Continued on LIC809C Continued from LIC 809C Licensee states residents' families coordinate and arrange transportation to and from their medical and dental appointments. Facility does not manage cash resources for residents. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit : 1)LIC610- Emergency Disaster Plan 2)LIC500 - Personnel Report 3)Updated Liability insurance 4)LIC9020 - Registration of facility residents. 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, or repeat violations, may result in a civil penalty assessment. Appeal rights provided to Licensee. Exit interview conducted with Licensee, whose signature on this document confirms receipt