Routine inspection·June 27, 2025

Licensing Program Analyst (LPA) Valeria Conway conducted an unannounced annual visit to this facility at 9:10 A.M., LPA met with caregivers Blaire Murphy and Sheryl De Guzman. Administrator was contacted via telephone. At 9:40 A.M. back up administrator Harold De Guzman arrived at the facility. Administrator Jocelyn Manacap arrived at 10:00 A.M. Entrance interview conducted. Beginning at 10:12 A.M., the LPA, along with 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. T his facility doesn’t have a staff room, facility will provide 24/7 care. The following was observed: BEDROOMS : The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are three (3) total bedrooms, all of which are designated for shared resident use, at the time of the visit only Room #1 is being shared. During the physical plant tour, LPA observed a camera in room #1. Administrator stated that camera is not functioning, and it was uninstalled during today’s visit. Technical Violation (TV) issued. Continued on LIC 809-C Continued from LIC 809 RESTROOMS : The LPA observed two (2) restrooms in the facility; one (1) is a shared restroom, and one (1) is a private restroom. Resident restrooms are clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. Between 10:38 A.M. and 10:56 A.M., hot water was measured. All bathrooms were within the required limit of 105-120 degrees Fahrenheit. COMMON SPACES : In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room was observed to be in good condition. The LPA observed the required postings in the common area. Hardwired combination smoke and carbon monoxide detectors were tested by staff at 9:50 A.M. and were functional at the time of the visit. Fire extinguishers were observed to be fully charged and last serviced on 06/27/2025. Facility is equipped with two fire doors to enhance safety and prevent the spread of fire. During today’s visit, LPA observed a door stop installed on the fire door in the common area leading to the resident bedrooms and in Room #1 keeping both fire doors obstructed. The facility serves residents with dementia, the auditory alarms on the exit doors were disconnected during today’s visit. Technical Violation (TV) issued. The facility maintained a comfortable temperature of 73 degrees. LPA observed a working phone available for residents use whenever needed. LPA also reviewed the facility's emergency disaster plan and the infection control plan, which needed to be updated with staff names responsible for assignments during an emergency and practices and procedures. Emergency disaster drills are being conducted quarterly. KITCHEN : Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. LPA conducted a review of expiration dates on product labels. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. Cleaning compounds were stored under the kitchen sink and separately from food supplies. At 11:04 A.M., hot water measured at 123.2 degrees Fahrenheit. Water heater temperature was adjusted during the visit. Continued LIC 809-C Continued on LIC-809C OUTDOOR SPACE : The side yard has a covered outdoor area equipped with furniture for resident to enjoy. There were no bodies of water noted. Facility provides sufficient space to accommodate both indoor and outdoor activities. Facility has two total gates; both were observed to be self-closing and self-latching gate with clear passageways for emergency exit use. RECORD REVIEW : Began at 11:45 A.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. LPA review four (4) resident records for regulatory compliance. During the review, LPA observed that the records for Resident # 1 (R1) and Resident #2 (R2) contained incomplete information and were missing required signatures. Furthermore, LPA did not observe a current appraisal form on file for any of the four (4) residents reviewed. LPA explained administrator the importance of updating in writing as frequently as necessary significant changes in resident’s condition. LPA reviewed five (5) staff files including the administrator. All files reviewed were complete and in compliance with regulations. GARAGE: The garage was observed locked. LPA observed extra non-perishable food, and a refrigerator with extra food. Furthermore, laundry area, as well as emergency food supply and water, and storage space was observed in the garage. All cleaning compounds were stored in areas separately from food supplies. LPA reminded administrator that given that there are no staff rooms, the facility is required to have 24/7 care, and that staff cannot use the garage or a common areas to sleep. MEDICATION REVIEW : All medications are kept in a hallway closet. This closet is locked at all time and medication are inaccessible to residents. LPA observed a complete 1 st aid kit including its manual inside that closet. Audit began at 12:46 P.M. Medications for all residents were observed to be in compliance with Title 22. Physician's Reports indicate Resident #3 (R3) is able to store and administer their own medications. Continued on LIC 809-C Continued from LIC 809-C During today’s visit, LPA offered administrator, Jocelyn Manacap, the opportunity to be referred to the Technical Support Program (TSP). LPA provided the following contact information for TSP services. TSP email address TechnicalSupportProgram@dss.ca.gov and their phone number (916) 654-1549. Additionally, LPA advised the ED to review the Provider Information Notices (PINs) on CCLD's website ( www.ccld.ca.gov ) for further guidance and updates. ED agreed to contact TSP for further information and assistance. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.