The facility’s fire clearance is approved for six (6) non-ambulatory residents, age 60 and over, with one (1) bedridden resident approved to reside in Bedroom #2. The facility also has a hospice waiver for six (6) residents. At the time of the inspection, no residents were receiving hospice care.

Facility Tour & Observations

Personal Rights postings (LIC 613C and Ombudsman), Complaint Poster (PUB 475), and nondiscrimination notice were observed posted in a common area. Residents had access to personal space, privacy, and adequate storage. No firearms or weapons were present.

Physical Plant

The facility is located in a residential neighborhood and is a single-story home consisting of five (5) resident bedrooms, two (2) bathrooms, a living room, family room, kitchen/dining area, front yard, backyard, and attached garage. All resident bedrooms observed contained the required furnishings, including beds, mattresses, linens, dressers, chairs, and adequate lighting. Sharps, cleaning supplies, and other toxic substances were observed to be inaccessible to residents. Sharps were secured in a kitchen cabinet under the sink. Cleaning supplies were secured in the garage/laundry area and in a cabinet under the kitchen sink. Bathrooms were observed to be clean and equipped with required grab bars near the showers and toilets, as well as non-skid mats. The hot water temperature was observed to be outside the required regulatory range of 105°F–120°F.(continued on 809C)

• Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

• Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

Food Service

Refrigerators and freezers were maintained at appropriate temperatures, with refrigerators at or below 40°F and freezers at 0°F. The facility maintained a sufficient food supply consisting of at least two (2) days of perishable food and seven (7) days of non-perishable food. Fresh produce, proteins, and dry goods were observed to be adequately stocked.

Health-Related Services & Records

Four (4) resident files were reviewed. Files contained required documentation, including Admission Agreements, signed consents, current Needs and Services Plans, Physician’s Reports documenting TB results and ambulatory status, and Resident Rights acknowledgments.

Medications for four (4) residents were reviewed. Medications were centrally stored and secured in a locked in a filing cabinet near the kitchen in the family room.

Disaster Preparedness

Fire and earthquake drill logs were not available for review at the time of the inspection. The LIC 610D Emergency Disaster Plan was available for review. Emergency supplies, including water, food, flashlights, batteries, and first aid supplies, were observed and available for use.

Personnel Records & Training

Three (3) staff files were reviewed and contained required documentation, including criminal record clearances, current CPR/First Aid certifications, and TB screenings. Administrator Maria Matias’ Administrator Certificate was observed to be current.

The facility was observed to be meeting applicable Title 22, Division 6 regulatory requirements at the time of the inspection. A few technical advisory notes were provided as reminders to support continued compliance.

An exit interview was conducted with Caregiver Loida Medina. A copy of the report was provided.