Routine inspection·May 8, 2025

At approximately 12:50 PM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by Caregiver. Administrator Josephine Sana was contacted and arrived at approximately 2:00 PM. Facility is a Residential Care Facility for the Elderly (RCFE) with four (4) residents in care. Facility has a Dementia Care Plan with one (1) dementia resident in care and is approved for all non-ambulatory residents. LPA was informed that one (1) resident was home with the rest at Day Program. At approximately 1:30 PM, 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 last inspected 5/24. Sprinklers and smoke/carbon dioxide detectors are hardwired and last serviced by vendor 8/24. Water temperature measured 110.2 degrees F and 111.2 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. Facility telephone was tested and operational during inspection. LPA observed toys, games, an activity schedule, musical instruments, and each resident is provided an internet accessible tablet. Continued 809C... Continued from 809... Facility conducts monthly disaster drills, and the most recent drill was conducted 4/25. LPA observed facility's infection control plan and emergency disaster plan which was last updated 4/24. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. At approximately 2:10 PM LPA conducted a review of four (4) resident records. All required documentation present. At approximately 2:30 PM LPA conducted review of five (5) staff records. All required documentation present. At approximately 3:00 PM LPA and Administrator conducted a spot check of medication and medication records. Medication is centrally stored and locked. At approximately 3:10 PM LPA and Administrator conducted check of P&I. All records present and cash is reconciled. Josephine Sana Administrator Certificate 7003793740 expires 2/21/2026. All fees are current as of this time. Updated copies of the following documents were received during this visit : LIC500 - Personnel Report LIC308 - Designation of Responsibility LIC400 - Affidavit Regarding Client Cash Resources LIC402 - Surety Bond LIC610D - Emergency Disaster Plan No deficiencies cited. Exit interview conducted with Administrator, whose signature on form confirms receipt.