Routine inspection·May 5, 2025

On 05/05/2025, Licensing Program Analysts (LPAs) Triel Lindstrom and Arielle Pascua arrived at the facility to conduct an unannounced annual inspection. LPAs Lindstrom and Pascua identified themselves, explained the purpose of the visit, and asked to meet with the Designated Facility Administrator (DFA). DFA Voica Matis arrived at the facility and a brief interview followed. DFA Matis accompanied LPAs Lindstrom and Pascua on the tour of the facility. This facility is a single-story residential home licensed to serve five non-ambulatory residents and one bedridden resident. It has a hospice waiver for two residents. Its fire clearance was issued by Modesto Fire Department on 09/28/23. The current census is five, including one resident on hospice. There were three staff on duty at the time this inspection, Arnel Arban,Ulna Tarrazona, and Rainilda Clavano. The annual inspection began with a records review. LPA Lindstrom requested all staff files. The review revealed that there are current records for health screening, required training, and first aid/CPR certification. LPA Lindstrom reviewed the Guardian background check list and verified that all staff has a criminal record clearance. LPA Lindstrom requested all resident files. The review revealed that all required paperwork is present. A tour of the facility was conducted. LPA Lindstrom then inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, laundry room, garage, storage areas, and back yard to ensure compliance with Title 22 regulations. The Administrator Certificate, Complaint Hotline Poster, Ombudsman information, menus, and resident personal rights are displayed in a central location. The tour began in the kitchen. LPAs Lindstrom and Pascua inspected the storage areas, counter surfaces, and appliances. These areas are clean, odor-free, operable, and pest-free. LPAs inspected the food supply located in the refrigerator, freezer, and pantry. The facility has a two-day supply of perishable food and seven-day supply of non-perishable food. Food containers are dated and labeled, and opened containers are resealed properly. Sharp objects and toxic chemicals are stored in locked cabinets, separately from food items and made inaccessible to residents in care. The tour progressed to the central medication storage area, which is located in the kitchen. Medication was stored separately from other items in a locked cabinet. LPAs Lindstrom and Pascua examined a sample of residents’ medications and compared it with the Medication Administration Records. The facility initials after administering each dose and keeps a separate log for the administration of PRN, OTC, and controlled medications. The first aid kit contain all required items. The tour progressed to the living room, dining room, hallways, and bedrooms. These areas have adequate furnishing, lamps, and lighting. Each resident has a bed, bedside table, chair, and chest of drawers, which are in good condition. These areas are clean and odor-free. The windows and window coverings are unbroken and operable. The tour progressed to the bathrooms. LPA Lindstrom measured the temperature of the hot water in one bathroom sink. Hot water temperature was measured at 111.2 degrees Fahrenheit, which meets regulation. The water fixtures work, the toilets flushes, grab bars are present and sturdy, and non-slip mats were observed and in good condition. The thermostat was set at 76 degrees. A fire extinguisher is located in the kitchen and was last serviced by Touch Down on 02/04/2025. The facility has an interconnected smoke alarm system and an individual carbon monoxide detector. The detectors were tested and an alarm sounded. The facility also has an ancillary fire alarm system. The facility has a written emergency disaster plan and a log that documents that disaster drills are held quarterly. The tour progressed to the laundry room, garage, and storage areas. These areas are clean. Toxic chemicals are stored in locked cabinets. An extra chest freezer and a refrigerator/freezer in the garage contains additional perishable food items. The tour progressed to outdoor areas. The grounds are well maintained. The lawns are manicured and weeded, the pathways are kept clear of vegetation, and downed vegetation and fallen fruit has been removed. There are two raised garden beds and a small tool shed in the backyard. There is an outdoor space f or residents to use with furnishings that are in good repair. The backyard fence is complete, sturdy, and in good repair. The side gate is self-closing and self-latching with hazards present. LPA Lindstrom requested that updated copies of these documents be emailed to her by 5:00 PM on Friday, May 9, 2025. (1) LIC 308 Designation of Administrative Responsibility (2) Cop y of Administrator Certificate (4) LIC 610 Current Emergency Disaster Plan (5) Proof of Current Liability Insurance (6) LIC 500 Current Personnel Report (7) LIC 309 Administrator Organization Based on the observations made during this visit, Per California Code of Regulations (CCR) – Title 22 – Division 6, Chapter 6, there are no deficiencies observed during today’s visit. An exit interview was held, and a copy of the report was provided was provided to the facility at the end of this visit.