Routine inspection·March 24, 2025

At approximately 9:30 AM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by Anabel Tuason, Caregiver. Administrator was at a patient evaluation and was unable to attend, Anabel Tuason is designated to sign and receive this report. 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 one (1) Hospice resident currently in care and is approved for all non-ambulatory residents of which two (2) may be bedridden. At approximately 10:05 AM, LPA initiated a tour of the facility with Caregiver and observed the following: Facility is a one-story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were last inspected 7/2024. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperature measured 108.5 Degrees F in kitchen sink, 106.1 Degrees F in shared bathroom, and 105.2 Degrees F in master bathroom, 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 2-day supply of perishable and 7-day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered, as well as an emergency water supply. There is a shaded seating area in the backyard with outdoor space for activities. LPA observed three locked sheds in the backyard which LPA inspected and observed the content to be decorations, winter coats belonging to staff, gardening supplies, and emergency supplies. Facility telephone was tested and operational during inspection. Continued 809C... Continued from 809... At approximately 11:10 AM LPA conducted review of four (4) staff records. All required documentation present. At approximately 11:40 AM LPA conducted a review of four (4) resident records. Three (3) of four (4) residents records did not contain an LIC 625 - Appraisal Needs and Service Plan. Deficiency Cited. At approximately 12:30 PM LPA and Caregiver conducted a spot check of medication and medication records. Medication is centrally stored and locked. LPA observed that Administrator submitted a re-certification request on 2/1/2025. LPA and Caregiver discussed facility's Infection Control Plan and Emergency Disaster plan, last updated 1/2025. Facility’s last quarterly disaster drill was conducted on 02/15/2025. The following updated documentation was received during this visit: Liability Insurance LIC500- Personnel Report LIC308- Designation of Responsibility Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Caregiver. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted with Caregiver and a copy of this report was given.