Routine inspection·June 25, 2025

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct a required annual visit. Upon arrival, the LPA met with staff and explained the reason for the visit. Staff contacted the Administrator telephonically and informed them of the visit. The Administrator, Walfre Alvizures arrived at the facility at approximately 09:40am. Entrance interview conducted. Starting at 09:45am, the LPA along with the Administrator 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 following was observed: KITCHEN: The LPA inspected the kitchen/food service area at 09:45am. Knives and sharps were observed in a box locked under the kitchen sink. Cleaning supplies are kept locked and inaccessible under the kitchen sink. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. COMMON AREAS: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. The LPA observed the fire extinguisher to be fully charged with a date of 03/13/2025. Required postings were observed throughout the common space. Report Continued on LIC 809C... Report Continued from LIC 809... The LPA observed two (2) fireplaces adequately covered at the time of the visit. Activities were observed in the living room and dining room. There is a working telephone on premises. The LPA observed a closet in the hallway with additional clean linens and towels. Auditory alarms were observed at the time of the visit. The LPA observed an adequate supply of emergency food and water. No obstructions or hazards observed inside or out. LAUNDRY ROOM: The laundry room is next to the kitchen. Laundry detergents and toxins were observed locked and inaccessible at the time of the visit. RESTROOMS: There are two (2) restrooms for resident use. Bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. Hand washing signs were observed posted at the time of the visit. The bathrooms were sufficiently stocked with supplies and paper towels. Personal hygiene items were also observed locked and inaccessible to residents in care. Starting at 09:54am, the hot water temperature was measured in bathrooms, and they measured within the required range of 105 – 120 degrees Fahrenheit at the time of the inspection. BEDROOMS: There are five (5) bedrooms for resident use. One (1) bedroom is designated for double occupancy and four (4) bedrooms are designated for private / single occupancy. All resident rooms were observed to be furnished appropriately with linens, appropriate furnishings, and sufficient lighting. The LPA observed a staff room on premises which was inaccessible to residents in care at the time of the inspection. Report Continued on LIC 809C... Report Continued from LIC 809C... OUTDOORS / SURROUNDING AREAS: The backyard was observed with two (2) sheds used for storage purposes inaccessible to residents at the time of the visit. There is one (1) side gate that self-latches. Property is fenced all around. The front yard has a covered patio area with patio furniture for resident use. All passageways were observed to be clear of any obstructions. No bodies of water noted at the time of the visit. RECORDS: The LPA reviewed Resident Records and Personnel Records starting at 10:15am. Six (6) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, preplacement appraisals, consent for treatment form, and current needs and services plan. During record review, it was revealed that 3 out of 6 residents did not have a preplacement appraisal on file, 4 out of 6 residents did not have an appraisal and/or needs & service plan on file, and 5 out of 6 residents do not have a signed consent for treatment for on file. The Administrator stated they would complete the missing forms for all residents. Per record review of Resident #1's (R1's) physician's reports dated 03/05/2025, it indicates R1's ambulatory status as bedridden and facility does not have an approved fire clearance for bedridden. R1 was moved out of the facility during today's inspection. Five (5) personnel files were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate yearly training. During record review, it was revealed that facility does not have a staff training binder; therefore, LPA was unable to verify yearly training for all staff. The Administrator stated they would work on completing all training for staff. Report continued on LIC 809C... Report Continued from LIC 809C... INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control plan. The facility’s policies and procedures as it pertains to infection control are adequate. MEDICATIONS: Medications review began at approximately 12:50pm. Medications are centrally stored in a locked cabinet by the kitchen. First Aid Kit and manual were observed and complete at time of the visit. Medications appeared to be given as prescribed at the time of the visit. Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8, the following deficiencies were cited (refer to LIC 809-D). An immediate civil penalty in the amount of $500 for fire clearance violation is being assessed today. Failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.