C-H #6 Residential Care for Elderly

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christian Gutierrez conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met with Administrator Adlean Ashley and explained reason for visit. The facility is licensed to serve up to (4) non-ambulatory residents ages 60 and older. The facility is a single-story home located in a residential area. A tour of the facility includes living room, dining room, kitchen, (3) client bedrooms, 1 staff room, 2 bathrooms, laundry room, attached garage with extra refrigerator and large freezer, front yard, and backyard. There are currently four (4) residents serviced by South Central Los Angeles Regional Center in care. All resident bedrooms were toured. Each bedroom has a bed, linen, dresser, and lighting. R4 had no pillows available in bedroom at time of visit. Smoke detectors were observed in each room and throughout facility. One carbon monoxide device was not working at time of visit, batteries were replaced. The facility has one (1) fire extinguisher that is fully charged in laundry room. Cleaning supplies, sharp objects, and toxic substances are inaccessible locked in laundry room. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F LPA did not observe a sufficient supply of 2-day perishable food. LPA did observe a sufficient supply of 7 days non-perishable foods in the kitchen. There are no firearms or weapons stored at the facility The resident bathrooms have the required grabs, bars and non-skid mats. The hot water temperature in the bathrooms were measured between the required range of 105-120 degrees F. Bathroom number one needed two light bulbs replaced. The common areas, including the living room and dining area, are clean and have the required furniture. The facility does not have a swimming pool or large body of water. There is a shaded seating area for the residents in back yard. Passageways and exits are free of obstruction. Four staff files reviewed and included Criminal clearance record, and health screening with TB, and CPR/First Aid certificates. Three staff did not have the required annual training. Four (4) resident files were reviewed and included physicians report, TB clearance, and appraisal needs and service plans. Last fire/earthquake drill was conducted in April of 2026. Infectious control plan was reviewed. Resident medications were reviewed, and one discrepancy was found. Medications are centrally stored. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809Ds. Exit interview was held and a copy of the report along with appeal rights were provided.the state’s words, verbatim · CDSS document, May 28, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA’S) Christian Gutierrez, and Gaby Castro conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA’s met Caregiver Yeneka Davis at approximately 9:38 AM and explained reason for visit. Administrator Ashley Fisher arrived shortly. The facility is licensed to serve up to (4) non-ambulatory residents ages 60 and older. The facility is a single-story home located in a residential area. A tour of the facility includes living room, dining room, kitchen, (3) client bedrooms, 1 staff room, 2 bathrooms, laundry room, attached garage with extra refrigerator and large freezer, front yard, and backyard. There are currently four (4) ambulatory residents serviced by South Central Los Angeles Regional Center. All resident bedrooms were toured. Each bedroom has a bed, linen, dresser, and lighting. Smoke detectors were observed in each room and throughout facility. Carbon monoxide device was not working at time of visit. The facility has one (1) fire extinguisher that is fully charged in laundry room. Cleaning supplies, sharp objects, and toxic substances are inaccessible locked in laundry room. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. LPAs did not observe a sufficient supply of 2 days perishable food. LPAs did observe a sufficient supply of 7 days non-perishable foods in the kitchen. There are no firearms or weapons stored at the facility The resident bathrooms have the required grabs bars and non-skid mats. The hot water temperature in the bathrooms were measured between the required range of 105-120 degrees F. The common areas include the living room and dining area are clean and have the required furniture. The facility does not have a swimming pool or large body of water. There is a shaded seating area for the residents in back yard. Passageways and exits are free of obstruction. Three (3) out of three (3) staff files reviewed and included Criminal clearance record, and health screening with TB, and CPR/First Aid certificates. Three (3) out of four (4) resident files were reviewed and included physicians report, TB clearance, and appraisal needs and service plans. R4 is missing admission agreement, medical assessment, pre- admission appraisal, appraisal needs and service plan, and consent forms. Last fire/earthquake drill was conducted in June of 2025. Infectious control plan was reviewed. One (1) staff, and three (3) residents were interviewed. Resident medications were reviewed, and no discrepancies found. Medications are centrally stored. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809Ds. Exit interview held and a copy of the report along with appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 3, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jose Villalobos conducted the unannounced Annual Inspection visit using the Compliance And Regulatory Enforcement (CARE) Tool. LPA met with Staff David Berry and the purpose of the visit was discussed. The following tool domains were completed: Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents’ medications. Staff are still cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan. Physical Plant and Environmental Safety: The facility is licensed to serve up to (4) non-ambulatory residents ages 60 and older. The facility is a single-story home located in a residential area. A tour of the facility includes: living room, dining room, kitchen, (3) client bedrooms, 1 staff room, 2 bathrooms, laundry room, attached garage, front yard, and backyard. There are currently (2) ambulatory residents serviced by South Central Los Angeles Regional Center. There are no bodies of water on the premises. The facility was inspected during the physical plant tour. No passageways or paths were obstructed. Water temperature in bathrooms tested at 114 and 115 degrees. The knives and sharp items are stored in a locked cabinet. Smoke and carbon monoxide detectors operational. The fire extinguisher was observed and is fully charged. Operational Requirements: Facility is operating within its approved clearance as there are only (2) Residents of which both are ambulatory. Activities Calendar observed. Liability insurance is maintained. Personnel Records-Training: Personal records centrally stored. LPA inspected six (6) staff files. All staff are background check cleared and associated with the facility. All the staff files have the required Title 22 documents. The administrators certificate is currently active. Continued on LIC 809-C Staffing: The facility has a sufficient amount of staff per shift in the facility. LPA reviewed staff roster to verify that there is a staff present during the Nightshift. Resident Rights-Information: Resident personal rights poster was observed. Other required postings also observed. Resident Records-Incident Reports: LPA reviewed (2) Resident Files during the visit. Resident files are kept locked in a file cabinet and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plans. Planned Activities: There are sufficient activities readily available for residents in care. Sufficient space for activities was observed. Food Service: Supply of Non perishables and perishables was observed. Food supply was adequately stored. Pesticides and other toxic substances were not stored with the food supply. Kitchen area was clean. Food menu was observed. Incidental Medical & Dental: All medications for residents are centrally stored and kept locked and inaccessible to other residents in care. LPA reviewed (2) Resident medications supply. No medication errors were observed. Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites. Last emergency drills conducted on 4/4/24 Residents with Special Needs: There are no residents who are bedridden or in need of postural supports in the facility. There are no residents in care receiving hospice services. There are no residents in care with prohibited health conditions. There are no residents in care with dementia. There is (1) residents in care receiving Home Health services for incidental medical care. Home health plan observed. Per Title 22 Regulations, no deficiencies are being cited on todays visit. Exit Interview conducted. A copy of the report was providedthe state’s words, verbatim · CDSS document, May 19, 2024