Routine inspection·April 15, 2025

Licensing Program Analysts (LPA) Alviso conducted a Required- 1 Year visit, on 4/15/25 at approximately 10:20am, and was greeted by lead staff Liza Fonseca. LPA observed a second caregiver, Ashley, working at the facility. Lead staff Fonseca has a current RCFE administrator certificate. There are six (6) residents in care. Facility has an approved dementia plan of operation. There is an approved hospice waiver for six (6) residents. Facility has a required infection control plan. Facility has a required emergency and disaster plan. Facility has a fire clearance approval for a total of six non-ambulatory, of which one (1) may be bedridden. Room #1 and #2 are fire cleared for bedridden use. Fire extinguishers were serviced and tagged as required. Facility has a carbon monoxide detector that worked properly during the inspection. All smoke alarms are hard wired and worked properly during the inspection. All exits were clear and unobstructed. The facility does have emergency food, water, and supplies to meet the "72 hour shelter in place" requirements. Per review of records, emergency disaster drills have been conducted as required; Last emergency disaster drills were conducted on 3/19/2025. LPA toured the facility with lead staff Liza. All exits were observed to be free and clear of obstruction. The LPA observed that the home was at a comfortable temperature for residents in care. The hot water was measured at 110.1 degrees Fahrenheit, which is within regulation. The bathrooms had grab bars and non-slip mats/flooring for resident use. There was sufficient lighting in all resident rooms, hallways, bathrooms, and common areas. Sufficient food supply of perishable and non-perishable food items. Continued on LIC809C... LPA observed the staff preparing the residents noon meal; LPA observed the residents having their noon meal during the inspection. There was a sufficient supply of furnishings for resident use. Sufficient supply of linens, cleaners/soap/disinfectants, hygiene products, paper products, and personal protective equipment (PPE) supplies. Medications were centrally stored and locked making them inaccessible to residents in care. Disinfectants/cleaners were observed to be locked up and inaccessible to the residents in care. The backyard was observed to be clean, orderly, and all pathways clear and free of obstruction. Fire exit gate was clear and unobstructed. The facility was observed to be clean and orderly during the inspection. LPA reviewed six (6) resident files, including medical assessments and medication records. LPA reviewed five (5) staff files. All staff have required criminal record clearance. Staff have required training. Staff have required first aid and CPR certification. LPA is requesting the following documents be updated and submitted by 5/15/25. LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E- Emergency Disaster Plan (ensure to review and update as needed/required- submit copy of review page or if changes submit copy of the plan. Infection Control Plan (ensure to review and update as needed/required- submit copy of review page or if changes submit copy of the plan. Copy of LIC400- Handling of Client Cash Resources (include copy of 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 was conducted with Lead Staff Liza Fonseca.