Routine inspection·October 6, 2023

Licensing Program Analysts (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit at 08:15 a.m. When the LPA arrived, there was two staff and five clients present. The LPA was greeted by Staff Emma Carranza and informed them of the reason for the visit. Administrator Alexander Tecson was unable to be present during todays visit and authorized staff Amelia Davis who arrived shortly to review and sign reports. At 8:45am the LPA conducted a tour of the physical plant with Staff Emma to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: Facility is a single-story residence that consists of five (5) resident bedrooms and three (3) bathrooms. There is caregiver lounge located in the backyard. The LPA observed (2) fully charged fire extinguishers last serviced on September 15,2023. All smoke alarms and carbon monoxide detector were tested and functioned properly during time of visit. LPA observed all required postings throughout the facility. The facility serves residents with dementia, however there were no auditory alarms on the exit doors during today’s visit. Kitchen : The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient amount of perishable and non-perishable food at the facility; Sharp objects are stored in a locked drawer. At 8:50 a.m. the LPA observed the kitchen sink in the process of being remodeled, however the home has a temporary makeshift sink that is operable. The LPA observed a bottle of Windex and a bottle of Palmolive liquid dish soap in the unlocked cabinet under the sink accessible to the residents in care. Bedrooms: The resident bedrooms were properly furnished with at least one chair, nightstand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Report will continue on LIC809-C. Common Areas: These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. The facility maintained a comfortable temperature of 74 degrees. Garage/laundry room: The garage is locked and used as a storage. The laundry equipment and cleaning supplies are kept in a locked outside laundry room. Surrounding Grounds (Outdoors) : There was a shaded area with proper furniture for outdoor use. There are no bodies of water on the premises. At 9:45 a.m. the LPA observed the following hazardous items in the backyard accessible to residents in care: two (2) hand-saws, multiple pliers, gardening tools, and paint. At 9:55 a.m. the LPA observed a pre workout container and vitamin container inside the caregiver lounge located in the backyard unlocked and accessible to residents in care. I nterviews: At 10:10 a.m. the LPA conducted two (2) resident and two (2) staff Interviews. No immediate concerns were voiced during todays visit. Due to time constraints the LPA will return to complete annual at a later date. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report and appeal rights provided.