MPS Home II

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 John Fernandez (caregiver) and explained reason for visit. Administrator Maria Tavarez was notified over the telephone. The facility is licensed to serve 4 non-ambulatory residents ages 60 and above, with a hospice waver for two. The facility currently has 4 residents all serviced through Harbor Regional Center, none of the residents are currently using hospice service.The facility is a single-story home located in Lakewood, Ca. A tour of the facility included: living room, dining area, kitchen, 4 resident bedrooms, 2 resident bathrooms, 1 staff bedroom with private bathroom, laundry area, attached garage, front yard and backyard. LPA toured the facility and observed the following: Each resident’s bedroom has the required bedding and furniture. There is extra clean linen and towels in hallway closet. Smoke detectors and carbon monoxide detectors were observed in each room and throughout the facility and are properly operating. The facility has two (2) fully charged fire extinguishers. Cleaning supplies, toxic substances, and sharps are inaccessible to clients in a locked cabinet under kitchen sink. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. There are cleaning supplies, hygiene products, and emergency food in garage. There are no firearms or weapons stored at the facility. The hot water temperature in the bathrooms were measured between the required range of 105-120 degrees F. The facility does not have a swimming pool or bodies of water on the premises There is a shaded seating area for the residents located in the backyard. Passageways and exits are free of obstruction. SEE LIC 809C Four (4) staff files were reviewed and included Criminal clearance record, CPR/training, and health screening with TB. Four (4) residents files were reviewed and included physicians report, TB clearance, and individual program plan (IPP)report. Last fire/earthquake drill was conducted in March of 2026. Infectious control plan was reviewed. A copy of updated Emergency Disaster plan was provided to LPA. Four (4) resident medications were reviewed. Medications are centrally stored and locked MAR log is used. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview was held and a copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 26, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mayra Cota conducted an unannounced required annual visit. LPA met with Belma Fernandez, Caregiver, and explained the reason for the visit. Administrator, Maria Tavarez, arrived thereafter and assisted with the visit. The facility is licensed to serve 4 non-ambulatory elderly residents, ages 60 and over, with a Hospice waiver for 2 residents. The facility is operating within the scope of its license. Clients receive services through the Harbor Regional Center. The facility is a single-story home located in a residential area of Lakewood, CA. LPA and Administrator toured the home and inspected the living room, dining area, kitchen, 4 resident bedrooms, 2 resident bathrooms, 1 staff bedroom with private bathroom, laundry area, attached garage, front yard and back yard. During today’s visit, LPA observed the following: Inside the home: Living room and dining area are clean and furniture is in good repair. Both areas have enough seating for residents. A fireplace was observed and is covered appropriately. Kitchen counter tops and meal preparation surfaces were observed clean and free of clutter. Kitchen appliances were observed in operable condition during time of visit. ***Continues on LIC 809-C Sharps/knives are kept locked in a kitchen cabinet. Cleaning supplies and toxins are also kept locked and inaccessible to residents in care. Sufficient supply of 2 day perishable and 7 day non-perishable food was observed and additional food is kept in an overflow refrigerator in the garage.. Several dry and canned food items were observed to be kept beyond the "best if used by" date in the kitchen pantry. Dry food containers were observed without an expiration label in the pantry. Client bedrooms have the required furniture such as bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space. Client beds have the required linen and mattress pads. Extra resident mattress pads, bed linen, absorbency pads (Chux), and towels are kept in a closet. Resident bathrooms were inspected and were observed clean. Safety mats were observed and showers are equipped with safety grab bars. The water temperature was tested in both resident bathrooms and measured at 109.2 degrees F in bathroom 1- and 109.5 degrees F in bathroom 2 which is within the required 105 - 120 degrees F. Personal hygiene products are readily available for residents in care. Outdoor environment: The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area accessible to clients, located in the backyard. Passageways and exits are free of obstruction. Attached garage was inspected and is used for storage. Garden area is well maintained and gardening tools were observed locked at the time of visit. Medication and Record Review: Resident medications are centrally stored and locked in medication cabinet. Medication was observed to be administered per physician's orders and documented accordingly on MAR logs. Four resident and five staff records were reviewed. Records reviewed have all required documents. ***Continues in LIC 809-C Disaster Preparedness: Combination smoke and carbon monoxide detectors were observed throughout the facility and were tested and working properly at the time of visit. Two fire extinguishers were inspected and were observed charged. Both were last serviced on 3/5/25. Extra emergency supplies like a flashlight and a food supply are kept in the garage. Facility is equipped with a backup generator. First Aid kit and manual are kept readily available for use. Ramps and stair cases are free of obstructions. A Technical Advisory is being issued and a Deficiency is being cited (See LIC 809-D) per California Code of Regulations, Title 22, and California Health and Safety Code Exit interview was conducted with the Assistant Maria Tavarez. A copy of the report, appeal rights was issued.the state’s words, verbatim · CDSS document, Apr 22, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced met with John L. Fernandez (Caregiver) and Belma Fernandez (Caregiver) [assistant administrator Marie Resurreccion arrived shortly after to assist with the visit], the purpose for today’s visit was explained. The facility is licensed to serve 4 non-ambulatory residents ages 60 and above, with a hospice waver for two. The facility currently has 4 residents all serviced through Harbor Regional Center, none of the residents are currently using hospice service. The facility is a single-story home located in Lakewood, Ca. A tour of the facility includes: living room, dining area, kitchen, 4 resident bedrooms, 2 resident bathrooms, 1 staff bedroom with private bathroom, laundry area, attached garage, front yard and back yard. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit todays visit and the initial visit and observed the following: Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents’ medications. Staff are cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan maintained at the facility. Operational Requirements: The facility has an approved fire clearance, there is a plan of operation with required Infection Control Plan and facility maintains the required liability insurance. Physical Plant & Environment Safety: LPA toured facility, residents’ bedrooms were checked and closet/drawer space to accommodate each resident comfortably was available. The front yard is free of debris/hazards and the outdoor and passageways are free of obstruction. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available for clients. The hot water temperature was tested throughout the facility and measured within the required range of 105-120 degrees F. All storage areas for cleaning solutions, toxins, knives, and hazardous items are kept in a locked and are inaccessible to residents. Smoke detectors and carbon monoxide detectors are operable and in compliance.There fire extinguisher was observed and is fully charged.(continued on 809-C) Staffing: There appears to be sufficient staffing at all times in the facility. With night staff (live in staff) that are trained and able to assist in care and supervision of the residents in the case of an emergency. Personnel Records-Training: Staff has criminal record clearance, current First-Aid/CPR/AED training along with training in postural supports, medication assistance, and other ongoing training are documented in personnel files. LPA reviewed 5 staff files with no issues observed. Administrator Richardo Banos certificate expires on 1/11/25. Resident Records-Incident Reports: Resident files are kept in a secure location and have the following documents in their files - Pre-admission appraisal/Appraisal Needs & Services Plan, Admission Agreements, Identification & Emergency Information and current Physician's Report. LPA reviewed 4 Resident Files with no issues observed. Residents Rights-Information: Residents are provided with telephone and internet at the facility. The facility has the following posters posted: Residents Rights, Complaint Poster, and Ombudsman. Planned Activities: Facility provides scheduled activities and have a variety of activities to choose from within the facility. There is an outdoor activity area available for the residents. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Incidental Medical & Dental: Medication is properly labeled and are centrally stored in a closet and are in their original containers. LPA reviewed 4 residents’ medications and there were no issues observed. Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. Last fire/disaster/earthquake drill was conducted on 4/2/24. Residents with Special Health Needs: There are no bedridden or residents with postural supports at this facility. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was emailed to Marie Resurreccion.the state’s words, verbatim · CDSS document, May 18, 2024