Routine inspection·September 25, 2025

At approximately 11:15 AM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to conduct a required 1-year annual inspection and was greeted by Mary Ann Ordono, Caregiver/Responsible Party (RP). Licensee was contacted via telephone and gave LPA permission to continue with the inspection with the RP. Facility is a Residential Care Facility for the Elderly (RCFE) with four (4) residents in care. All residents were present during today's inspection. Facility has a hospice waiver for four (4), a bedridden waiver for one (1), and is approved for all non-ambulatory residents, and currently has one (1) hospice resident in care. At approximately 11:30 AM, LPA initiated a tour of the facility with RP and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens and paper products available to residents. Residents' bedrooms were inspected and observed to have the appropriate furnishings as outlined in Title 22 regulations. Bedroom #6 was noted to have medium pile carpet and smelled of urine with RP agreed and licensee indicating the incontinent resident will be moved to a room with laminate flooring and the room will be thoroughly cleaned. (technical violation issued). A rear staff bathroom was noted to have stained baseboard and previously wet sheetrock and licensee was advised to replace both, in addition the top of the refrigerator and microwave hood require cleaning and a technical violation was issued. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. There is a covered seating area in the enclosed front yard with outdoor space for activities. LPA observed a locked shed in the backyard which LPA inspected and observed the contents which consist of tools, chemicals, and extra facility equipment. LPA observed an activity schedule and was informed that the facility conducts morning exercises at least 4 times per week. LPA observed games, puzzles, and activities for residents in care. Facility's fire extinguisher was observed charged and was last serviced February 2025. Smoke and Carbon Monoxide detectors were tested and operational during inspection, as well as, no-smoking signs and oxygen in use signs were posted. Continued on LIC809-C... Continued from LIC809... Facility conducts quarterly disaster drills, and the most recent drill was conducted July 2025. LPA observed the facility's infection control plan, first aid kit, PPE, and other emergency supplies. LPA reviewed facility's emergency disaster plan which was llast updated July 2025. At approximately 11:50 AM, Licensee, Charmaine Menderos arrived. LPA reviewed five (5) staff files. One (1) staff file was not available, one (1) staff had no evidence of 1st Aid/CPR training or finger printing and criminal exception to review. One (1) staff had no evidence of initial 20 hours of training and four (4) or five (5) staff present were not listed on Guardian website as being cleared to work at the facility (Type A citation and POC issued) LPA conducted file review of all five (4) resident files and observed all four (4) files contained all the required documents per Title 22 regulations. During the course of staff record review licensee and staff provided additional documents from a sister facility or from licensee's phone and licensee was reminded of the need for complete employee records to be maintained on site at all time and a technical violation was issued. In addition, LPA advised Licensee to ensure all documents are signed and dated. At approximately 2:00 PM, LPA reviewed medications and medication records which are maintained and stored in compliance with regulation. Licensee states facility and residents' families work together to coordinate medical and dental appointments and residents' family coordinate transportation to and from visits. Facility does not manage cash resources for 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, may result in a civil penalty assessment. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit : LIC610 Emergency Disaster Plan (updated) LIC500 Personnel Report (updated) LIC308 Designation of Responsibility (for any changes) Updated Proof of Liability Insurance This report was reviewed with Licensee Charmaine Mendnaros and Appeal rights were given.