Routine inspection·May 7, 2025

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 9: 45 a.m. Upon arrival, LPA Mosley was greeted by staff and called the Administrator to inform them of the visit. The Administrator arrived shortly after. The LPA met with Administrator Erlinda Gonzales and explained the reason for the visit. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. INTERVIEWS : From 9:55 a.m. – 10:16 a.m. One (1) staff and two (2) resident interviews were conducted during the inspection. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit. COMMON AREAS : At the time of the visit, furniture in the common areas were observed to be in good condition. The facility maintained a comfortable temperature. At 1:11 p.m., smoke detector(s) and carbon monoxide detectors were tested and operational at the time of the visit. The fire extinguishers were observed and fully charged on 12/17/2024. The LPA observed required postings throughout the common space. The last emergency disaster drill took place sometime in January 2025 and was not documented which poses/posed a potential health, safety or personal rights risk to persons in care. The Administrator was informed about the importance of emergency disaster drills and agreed to conduct a drill tomorrow and submit proof to CCLD. Report Continued on LIC 809C PAGE 2... (PAGE 2) Report Continued from LIC 809... Activities were observed in the common areas. An adequate supply of emergency food and water was observed. The facility has a working telephone on premises. Auditory alarms on all doors were functional at the time of the visit. Entry/exits in the home were free of obstruction. Inside temperature was maintained at a comfortable level. KITCHEN: The LPA inspected the kitchen/food service area at 10:16 a.m. Knives and sharps were observed in a locked cabinet under the sink. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 110.4 degrees Fahrenheit at 10:21 a.m. BEDROOMS: The facility is a single-story residential home with six (6) bedrooms of which six (6) are for resident use. Resident bedrooms are private, single occupancy. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. BATHROOMS: The facility has a total of four (4) bathrooms. Two (2) are private resident bathrooms and two (2) are shared, common bathrooms for resident use. Restrooms were clean and sanitary and in operating condition with grab bars and slip resistant surfaces. Hot water was measured in all resident bathrooms from 10:21 a.m. - 10:38 a.m. and measured between 109.8 – 110.8-degree Fahrenheit within the required range. The sinks had sufficient liquid soap, and paper towels. At approximately 10:31a.m. LPA observed that the private bathroom in bedroom # 6 was an alteration and does not have a permit which poses/posed a potential health, safety or personal rights risk to persons in care. OUTDOOR SPACE/ GARAGE: The LPA observed the back yard which had four (4) portable outdoor umbrellas for shade along with patio furniture including tables and chairs for resident use. The LPA observed the right-side gate that self-latches with a clear passageway in case of an emergency. The left side gate was blocked by a ladder, wheel barrel, generator, cart, paint gallons posing an immediate health, safety or personal rights risk to persons in care. Administrator was informed of the dangers and advised to relocate all the items at the time of the visit. There were no bodies of water observed on the premises at the time of the visit. The garage is kept locked and inaccessible to residents. Report Continued on LIC 809C PAGE 3... (PAGE 3) Report Continued from LIC 809C PAGE 2... LPA observed an extra freezer with extra food that was checked for proper labels and expiration dates. Laundry units observed in the garage. Cleaning solutions, laundry detergent, toxins, chemicals, and hazardous items were inaccessible and locked away in the garage. At approx. 10:42 a.m. LPA observed an alteration to the garage of a wall that was added for a staff room that includes a bed, storage space and does not have a permit which poses/posed an immediate health, safety or personal rights risk to persons in care. The facility was cited last year for having a storage area that was converted to a staff sleeping area. The Administrator agreed to not allow staff to sleep in the area and clear out all furniture (bed). RECORDS : Records review began at 10:54 a.m., five (5) resident records were reviewed for, but not limited to: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All records in order. At 11:40 a.m. five (5) Personnel records including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. Infection Control / Emergency disaster planning: During today’s visit LPA Mosley reviewed the facility’s infection control practices and the facilities emergency disaster plan. The facilities policies and procedures as they pertain to infection control and emergency preparedness are adequate. MEDICATIONS: Medications review began at approximately 2:03 p.m. Medications are centrally stored and locked in a closet adjacent to the entrance. Medications for four (4) residents were reviewed. Medications are labeled and checked for expiration dates. All medications were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed. Documents obtained during the visit include: LIC 500 facility roster, LIC 9020A Resident roster, and current Liability Insurance. An updated facility sketch was requested. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. The Licensee was made aware that failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.