Routine inspection·July 17, 2025

On 7/17/2025, Licensing Program Analyst (LPA) Hansen conducted an unannounced Annual inspection of this facility and was welcomed by Licensee Roxana Galo. This Residential Care Facility (RCFE) is single story with 4 bedrooms, has a fire clearance for 6 nonambulatory, currently provides care for six (6) residents two of which have a diagnosis of dementia and one receiving hospice services. Facility has an approved Hospice Waiver for 2. At approximately 11:25 AM LPA conducted tour of the facility with Licensee, facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. The bathrooms designated for residents at the facility were supplied with paper towels and hand soap dispensers. Hot water temperature measured between 111.7 degrees F and 113.9 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 2 of 2 resident’s bathrooms while touring facility. Bathrooms were equipped with necessary grab bars and slip-resistant mats, strips, or flooring were used in all bathtub and shower floors as required by Title 22 regulations. All bedrooms have lighting & appropriate furnishings per Title 22 regulations. There was a supply of hygiene products and paper products available for residents. Smoke detectors and carbon monoxide detectors were all found to be in working order. Medication and file storage is stored in a secured cabinet located in Administration area adjacent to kitchen. Working auditory alarms are placed on all exits. Toxins, cleaning supplies, and sharps were all found in locked cabinets inaccessible to residents in care. Continued on LIC 809-C Continued from LIC809: File Review began at 12:15 PM: A review of six residents & three staff records as well as two resident’s medications was conducted. LPA learned that 6 out of 6 residents have updated Appraisals as well as medical assessments. Review of staff records, staff and other individuals who require caregiver background checks have received criminal record clearances or exemptions; In addition, Direct care staff have received the additional training requirements, LPA was also provided required proof of CPR & 1 st Aid certification for all staff. Medication Audit began at 1:45 PM: Medications were centrally stored in locked cabinet in Admin area adjacent to kitchen. LPA reviewed medications of 2 out of 2 residents were found to be given according to physicians’ directions. Centrally Stored Medication Record (CSMR) of 2 out of the 2 residents reviewed medications were found to have all medications entered for residents. Disaster Drills have been conducted quarterly and in different shifts, with the last being conducted on 3/5/2025. Fire Extinguisher was found to be last serviced on 12/27/2024 at the time of the visit. LPA was informed by Licensee that Administrator Elia Cuevas has not worked at facility since May 2025 and has provided initial documentation for staff Angelica Lopez LVN to be changed to Administrator, also provided proof of submission of Administrator training. Will submit certificate when arrives. No citations given at today’s visit LPA Hansen is requesting Licensee to update the following documents and submit to CCL by 8/7/2025: LIC 308 Designated (if changes) LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (if changes) LIC 9020 Register of Facility Resident’s Copy of Control of Property Lease-Deed Copy of Administrator Certificate Copy of Certificate of Liability Insurance