Routine inspection·April 17, 2025

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required Inspection and met with Robertson Cirineo, Administrator; Josephine Credo, Licensee arrived later. There are currently residents with a diagnosis of Dementia. Required postings were observed. Annual fees current. LPA/Administrator initiated a tour of the facility at 9:00am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Water temperature in resident's bathroom measured at 107.4, 105, 117.1 and 118 degrees F which are within allowable range of 105 to 120 degrees F. Extra hygiene products and linens were available. Bathrooms had required bath mats and grab bars. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Five out of five fire extinguisher were last inspected July, 2024. Facility has a centralized smoke detector system that was last tested July 10, 2024. Carbon monoxide detector was tested and operational. Exit doors have auditory alert system and were functional at time of visit. Medications were centrally stored and locked. LPA reviewed the facility emergency disaster plan with staff. Facility has a generator to supply power during an outage. The plan outlines evacuation routes, which are shown on facility sketch and has alternative meeting locations. Facility did not has enough food supplies to operate for more than 72 hours during an emergency (Technical violation issued). Last Emergency Disaster Drill was conducted on 2/4/25. At approximate 9:15am LPA/Administrator observed three oranges, seven bananas and twenty six apples, which is not adequate supply of perishables for at least two days. However, one week of non-perishable foods was observed in stock. LPA have a discussion with Licensee regarding the importance to have an adequate supply of fruits and vegetables as indicated per regulation. Continued on LIC809C... Continued from LIC809... LPA initiated file review at 10:00 am. Three staff files and eight resident files were reviewed. Staff files reviewed have required First Aid and CPR certificates and training hours complete. Six out of eight (R1, R2, R3, R4, R5 & R6) needs and services plan needs to be updated. The facility is a one story building and has an approved fire clearance dated February 9, 2011 that allows for 23 non-ambulatory residents and no bedridden resident. However, during records review one (R4) out eight residents have a bedridden status and are occupying room #7, which are not cleared by the Fire Department as bedridden rooms. Licensee is operating outside the limitation of the license by accepting a bedridden resident in a non-ambulatory room. LPA/Licensee discussed the issue about R4 to provide the option to submit a request to obtain updated physician's report, because according to the Licensee, R4 is not bedridden and they will obtain an updated physicians' report (LIC602). During the visit, LPA spoke with R4 who was observed and expressed that they are not fully bedridden and they are in agreement to obtain an updated medical assessment. Administrator Certificate for Administrator, Robertson Cirineo, 6042225740, expires on 10/3/27. Medications and medication records were reviewed. On 3/7/25 LPA Cuadra was notified by the Licensee that the project of building additional rooms located at the back of the building that will be used for single/shared occupancy for the same capacity of residents is complete and requested an updated fire clearance to get approval for space modifications performed to ensure fire code compliance. On 4/1/25, LPA Cuadra received a call from fire inspector requesting a 30 day extension to approve fire clearance due to some issues involving both parties regarding fire sprinkler installation. During today's visit, LPA toured the additional rooms involved in the updated fire clearance did not observe any evidence of resident's belongings in area. Administrator to submit updates of the following documents by 4/24/2025: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500) and Liability Insurance Certificate. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview was conducted with Licensee Josephine Credo and A copy of report was provided.