Routine inspection·June 17, 2025

At approximately 9:15 AM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by Caregiver. Licensee Alicia Poquiz was contacted and arrived at approximately 10:30 AM. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for three (3), with zero (0) Hospice residents currently in care, and is approved for four (4) non-ambulatory residents. At approximately 9:50 AM, LPA initiated a tour of the facility with Caregiver and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were observed charged and last inspected 6/24. Licensee stated fire inspection will be occurring 7/25. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperature measured 105.4 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, as well as an emergency water supply. Food was found to be stored in a safe manner with open items covered. There is a shaded seating area in the backyard with outdoor space for activities. LPA observed one locked shed in the backyard which was inspected and observed to be a staff room. Facility has an internet access devise and internet available to clients in care, and the phone was tested and operational during today's inspection. Continued 809C... Continued from 809... Facility conducts quarterly disaster drills, and the most recent drill was conducted 4/25. LPA observed facility's infection control plan and emergency disaster plan. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. At approximately 11:00 AM LPA conducted review of three (3) staff records. All required documentation present. At approximately 11:30 AM LPA conducted a review of three (3) resident records. All required documentation present. At approximately 11:40 AM LPA and Caregiver conducted a spot check of medication and medication records. Medication is centrally stored and locked. Renewal paperwork for Administrator Certification has been submitted, Licensee shall submit certification to CCL when received. Updated copies of the following documents shall be submitted to CCL within 30 days of this visit : Liability Insurance LIC500 - Personnel Report LIC308 - Designation of Responsibility LIC400 - Affidavit Regarding Client Cash Resources LIC610E - Emergency Disaster Plan No deficiencies cited. Exit interview conducted with Licensee, whose signature on form confirms receipt.