Routine inspection·September 29, 2025

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 10:31AM. The LPA met with the Administrator Maria Lourdes Ricafort and informed them of the reason for the visit. Entrance interview conducted. Beginning at 10:42AM, the LPA and Administrator toured the physical plant areas inside and outside to ensure there were no health and safety hazards, and the facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: The LPA observed two (2) knives above the kitchen sink on the drying rack, and the knife drawer was not locked during the tour. The Administrator stated that they were in the process of cleaning, however between 10:31AM and 10:42AM, the LPA observed the Administrator enter and exit the kitchen several times. The Administrator locked the knife drawer. Kitchen appliances were clean and in operable condition. The facility had a supply of perishable and non-perishable food. Food in the refrigerator and freezer were observed to be properly stored and of good quality. Report Continued on LIC 809-C COMMON AREAS: At the time of the visit, the living room and dining room furniture was observed to be in good condition. The living room had an attached garage entrance. The garage contained general storage, cleaning supplies, emergency food and water, extra supply of facility food, and laundry machines. The laundry machines were observed to be in good condition. Emergency food was observed to be expired from 01/2025 to 08/2025. The Administrator stated that they update the food supply monthly. The Administrator initially reported that the garage door remained unlocked during the day and is locked at night and expressed no concerns because Resident #1 (R1) was bed bound. The LPA explained that due to the cleaning supplies stored in the garage, the garage must always remain locked. Required postings were observed in the facility’s hallway in addition to locked cabinets that contained files and medications. The facility maintained a comfortable temperature throughout the visit. BEDROOMS/RESTROOMS: There were five (5) total bedrooms: one (1) bedroom occupied by the Administrator, two (2) private resident bedrooms, and two (2) shared resident bedrooms. Bedrooms #3, #4, and #5 had direct exits to the outside. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Extra linens were stored in a closet in the hallway. The LPA observed one (1) additional individual (I1) who resided with R1 in Bedroom #5. The Administrator stated they were related, and the LPA had a discussion and provided the Administrator options on the operation of the facility regarding I1. There were two (2) total restrooms in the facility: one (1) common restroom and one (1) private resident restroom. Restrooms were clean, sanitary, and in operating condition with grab bars and non-slip surfaces. All restrooms were sufficiently stocked with soap, paper products, and displayed hand washing signs. Hot water was tested and measured between 113 degrees F and 116.8 degrees F. Report Continued on LIC 809-C OUTDOOR AREA: The surrounding grounds were equipped with furniture for residents and visitor use. There was one (1) emergency exit door located on the side of the facility. All exits and passageways were free of obstruction. The LPA observed a shed in the backyard that contained general storage. RECORDS: Record review began at 11:06AM. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan. The infection control plan was completed and reviewed annually as required. The Administrator was unable to provide the emergency disaster plan and stated they did not recall where they put it. Emergency disaster drills are not conducted quarterly, with the last documented drill on 04/02/2025. The Administrator stated they forgot to conduct a drill in August, although the next documented quarterly drill was due in July. Smoke and carbon monoxide detectors were tested at 1:17PM and were operational. Fire extinguishers were observed throughout the facility and were last serviced on 06/02/2025. Report Continued on LIC 809-C MEDICATIONS: Medication review began at 1:20PM. Medications were centrally stored and kept inaccessible. Medications were observed for one (1) resident. Medications were labeled and checked for expiration dates and were not properly documented on the centrally stored medications and destruction record (CSMDR). R1 was prescribed Docusate Sodium 100MG filled on 09/23/2025 and Acetaminophen 325MG PRN (as needed) filled on 09/02/2025; both medications were not documented on the CSMDR. The Administrator stated that both medications were PRNs and R1 did not take them often. The LPA observed that only one (1) medication was a PRN, and the Administrator then stated that R1 did not like to take the other medication. The Administrator did not have documented logs of R1’s refusals in addition to a PRN Authorization Letter. R1 was also prescribed Amlodipine Besylate 10MG, Atorvastatin Calcium 40MG, Clopidogrel Bisulfate 75MG, Dutasteride 0.5MG, Nebivolol HCL 5MG, and Tamsulosin HCL 0.4MG which were not accurately recorded and had the incorrect expiration date, fill date, and start date on R1’s CSMDR. Pursuant to Title 22 CA Code of Regulations and/or Health and Safety Code, the following deficiencies were cited (Refer to LIC 809-D). Exit interview conducted. A copy of the Appeal Right and report was reviewed and provided.