Routine inspection·June 23, 2025

Licensing Program Analyst (LPA) Teresa Camara arrived at the facility unannounced to conduct a required annual inspection. LPA met with Operations Manager Angelica Arambulo and explained the reason for the visit. LPA, along with the Manager, 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. The facility's last fire inspection was completed on 1/28/2025 with no concerns noted. LPA tested the carbon monoxide detector which functioned properly during the visit. Fire extinguishers appeared fully charged and were last serviced 12/2024. RESIDENT ROOMS/RESTROOMS: Resident rooms are either single or double occupancy. 10 (ten) resident rooms were observed during today's visit and contained the appropriate furnishings, linens, and bedding. Resident restrooms are jack-and-jill style - shared between 2 adjacent rooms. Restrooms observed were clean and sanitary in operating condition. Water temperature was tested in a sample of resident restrooms and measured at 106.1 degrees Fahrenheit which is within the required range of 105*F-120*F. COMMON AREAS: Laundry room door lock was broken at the time of the visit. Laundry detergent was observed to be accessible in the laundry room. The facility has shower rooms for residents with non-slip surfaces. LPA observed the surfaces were not non-slip when wet. The Manager stated they would get non-slip mats for the shower rooms. KITCHEN/DINING ROOM: The dining room was properly furnished and is also utilized as an activity area. The facility had a sufficient supply of food (perishable and non-perishable) and water. Kitchen appliances appeared functional. (continued on LIC809-C) (continued from LIC809) BUILDINGS AND GROUNDS: This facility is fully fenced and has a fire clearance for secured perimeter. There is covered seating on the patio for residents' use. STAFF: LPA spoke with three (3) staff; there were no concerns noted. LPA reviewed five (5) staff files and all were complete. Documents reviewed included, but were not limited to, training records, TB test results, health screenings, and fingerprint background clearance. RESIDENTS: LPA attempted interviews with residents, however due to cognitive decline was not able to complete the interviews. LPA reviewed five residents' files and all were complete. Documents reviewed included, but were not limited to, physician's reports, admission agreements, personal rights, and needs and services plans. MEDICATIONS: LPA reviewed medications which are stored in the locked medication room. The facility utilizes Medication Administration Records (MAR) to ensure medications are given correctly. The facility has Centrally Stored Medication and Destruction Records (CSMDR) created by the pharmacies, however the start dates for medications were not transferred to these forms. The Medication Technician was informed these dates must be transferred to the CSMDR. Otherwise, the medications reviewed appeared to be given as prescribed and the medications were properly labeled. The first aid kit is also stored in the locked medication room. 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 additional civil penalties. Exit interview conducted. A copy of today's report and appeal rights were provided.