St Andrew's Home for the Aged 2

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. At around 1 PM, LPA Tea was greeted and granted entry into the facility by care staff and explained the reason for the visit. The administrator (AD) Victoria Valencia arrived shortly to assist with the visit. The facility is licensed for four ambulatory residents and two non-ambulatory with a hospice waiver for two. Currently there are six residents. LPA Tea reviewed six resident files and four staff files. Resident files and staff files contained all required documentation. Upon review of records, the facility is up to date with required quarterly emergency disaster drills, which were last conducted on November 7, 2025. AD Valencia administrator certificate has an expiration date of October 31, 2027. LPA toured the physical plant, checked food service, and the first aid kit. The facility is one story home, three resident bedrooms, two staff rooms, three bathrooms, living room, family room, dining area, staff office area, kitchen and attached garage. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, and showers were free of mold/mildew. Water temperature measured around 107. 7 Fahrenheit degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards; doorways were free of obstructions. First aid kit had all the required elements including dressing, bandages, tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked (Annual continuation on LIC809-C) and adequately stocked at time of visit. LPA observed sharps locked and inaccessible to residents in a kitchen drawer. LPA also observed toxin substances secured underneath the kitchen sink. The fire extinguishers are fully charged throughout the facility. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample seating with shade in the backyard. There is a barbecue grill in the backyard. There are two exit gates that are self-latching and operational on both sides of the house. LPA observed PPE supplies, emergency food and water stored in the garage. Facility provides activities based on their personal choice. The staff takes residents out to the outings like the park, going to the beach, eating out, and shopping. At the time of the visit, LPA observed residents lounging in the family room. LPA reviewed medication storage and administration. Medications are stored in a locked cabinet near the staff office area. Medications are being administered per physician order. P&I funds were accounted for and there were no discrepancies. LPA interviewed residents regarding their quality of care and spoke to staff present regarding care provided. Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with Administrator Victoria Valencia and a copy of this report LIC809, along with the 809-C, LIC858, and LIC859 were read and provided to the facility.the state’s words, verbatim · CDSS document, Jan 16, 2026

Type of visit: Required - 1 Year

On this day Licensing Program Analysts (LPAs) Michael Tea and Fred Arias made an unannounced visit to conduct a required annual visit. LPAs were greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for 4 ambulatory and 2 non-ambulatory residents. The home currently has 4 residents. Administrator (AD) Victoria Valencia arrived shortly to conduct facility tour. AD Valencia has a valid certificate that expires on 6/30/2025. AD provided updated liability insurance that expires on 6/29/2025. LPAs along with Administrator Valencia toured the facility at 2:50 PM. LPAs toured the physical plant, checked food service, facility documentation and the first aid kit. The home consists of 3 resident bedrooms, 2 staff bedrooms, living room, dining room, and kitchen as well as 3 restrooms. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 113.7 degrees F and 114 degrees F in all restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Auditory exit alarms were operational during today's visit. LPAs toured the kitchen and observed sharps locked in a cabinet during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPAs reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility conducts quarterly emergency drills with the last drill conducted on 12/16/2024. Outside grounds were toured. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. First aid kit contained all required items including tweezers, scissors and thermometer. Facility conducts activities in the form of exercise, games and community outings. There is shaded outdoor seating for residents. Exit gates are unlocked and operational. LPAs observed the emergency food and water supply. LPAs reviewed four resident files and three staff files. CONTINUED ON LIC 809C DATED 1/13/2025 All resident files contained required documentation including admission agreements, physician reports, resident appraisals, and physician orders. Staff files reviewed contained required documentation including required annual training, medical assessment/ TB, criminal record clearance and proof of CPR training. LPAs reviewed medication storage and administration. Medications are stored in a locked cabinet. Based on the observations made during today’s visit, one deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided.the state’s words, verbatim · CDSS document, Jan 13, 2025

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced health and safety case management visit. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the visit, LPA toured the facility and observed lunch being served. LPA observed a green salad, tuna casserole and garlic bread. LPA observed the food supply. There is ample fresh foods including varying vegetables, apples, bananas, watermelon and oranges. Facility indicates roughly following the menu and LPA observed ingredients matching the menu items. Facility documents what Resident 1 (R1) eats for each meal and LPA observed the documentation which indicated balanced meals. Resident 1 is not present during today's visit. During the visit, LPA consulted with Administrator regarding food choices and resident personal rights regarding food choices. Exit interview conducted and a copy of this report will be emailed to Administrator..the state’s words, verbatim · CDSS document, Jul 11, 2024