Routine inspection·April 10, 2025

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 4/10/25 at approximately 10:00am, and met with Licensee/Administrator Claudia Quijada. There are currently two (2) residents in care and both are on hospice services. Lead staff/caregiver Berta, and Caregiver Yolanda were on duty during the inspection.. Facility has an approved dementia plan of operation. There is an approved hospice waiver for two (2) residents. Facility has an infection control plan as required. Facility has an emergency disaster plan as required. Facility has a fire clearance approval for a total of five (5) non-ambulatory, of which two (2) may be bedridden, resident rooms #1 and #2. All locks on exterior gates are approved. The self latching fire exit gate is never to have a lock on it. The facility does have emergency food, water, and miscellaneous supplies to meet the "72 hour shelter in place" requirements. Required fire drills/emergency drills are being conducted as required; Last drill, Earthquake, was conducted on 2/28/2025. LPA reviewed two (2) resident files; Resident files were complete. LPA reviewed two (2) staff files. LPA reviewed staff training. All staff have criminal record clearance, and are associated as required. All staff had required training. All staff had current First Aid and CPR Certification. The LPA toured the facility with staff Berta Calderon. Hot water was measured at 112.8 degrees Fahrenheit. Continued on LIC809C... LPA observed that the facility was at a comfortable temperature. Food supply was sufficient. Facility had grab bars and a non-slip mat in shower stall for resident use. Sufficient lighting in all resident rooms, bathrooms, hallways, and common areas. Sufficient supply of cleaners/disinfectants, linens, furnishings, paper products, hygiene items, and personal protective equipment (PPE). All medications were centrally stored, locked up, and inaccessible to residents in care. Cleaners/disinfectants are locked up and inaccessible to residents in care. LPA is requesting the following documents to be updated and submitted by 5/10/25: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E (9 pages)-Emergency Disaster Plan -review and update as needed/required, submit copy Infection Control Plan- review and update as needed/required, submit copy Copy of LIC400 Handling of Client Cash Resources-all facilities complete this form Copy of Required Surety Bond- if handling cash Copy of Current Liability Insurance Resident Roster Copy of current Administrator Certificate There are no deficiencies cited today. Exit interview conducted with Administrator/Licensee Claudia Quijada.