Routine inspection·January 9, 2025

Licensing Program Analyst (LPA) Teresa Camara arrived at the facility unannounced to conduct a required annual visit. LPA met with Administraor Adelaida Cruz and explained the reason for the visit. Beginning at 1:24 p.m. LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The following was observed: Fire extinguishers are fully charged and last serviced on 1/17/2024. Smoke detectors and carbon monoxide detector were tested and functioned properly during today's visit. KITCHEN : LPA observed the kitchen to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable food, however there was an insufficient supply of non-perishable food (at least seven (7) days) and water (need a minimum of 18 gallons at all times). Cleaning supplies are stored under the sink in a locked cabinet. Knives are stored in a locked drawer in the kitchen. Daily medications are stored in a locked drawer in the kitchen. COMMON AREAS : This includes the living room, family room, and dining room areas. LPA observed common area to be clean and properly furnished at the time of the visit. The facility has two (2) fireplaces - one (1) in the living room and one (1) in the family room. Both were observed to be adequately screened. BATHROOMS : There are three (3) bathrooms; two (2) are shared and one is in a private room. Restrooms were observed to be equipped with nonskid surfaces. Grab bars were observed in the bathrooms. The water temperature was measured and was found to be in compliance with regulation. Report Continued on LIC 809-C Report Continued from LIC 809 BEDROOMS : There are seven (7) total bedrooms in the facility; six (6) bedrooms are designated for private resident use and there is one (1) staff room. The staff room is kept locked. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. GARAGE : Garage was observed locked and contained laundry area, extra perishable food, PPE, incontinence supplies, and additional chemical storage. OUTDOOR SPACE: The backyard has a covered patio area with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. There were no bodies of water on the premises. RECORD REVIEW: Began at 2:45 p.m. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. Four (4) staff files and six (6) resident files observed were in compliance with regulation. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly, with the last drill conducted in 1/5/2025. Emergency disaster plan was observed to be complete and updated annually, as required. MEDICATION REVIEW: Began at 3:30 p.m. Medications for two (2) residents were observed. All medications observed were labeled, stored, and properly documented at the time of the visit. INTERVIEWS: During today's visit, LPA interviewed two (2) staff, two (2) residents, and one (1) visitor. There were no concerns. 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. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.