Pacifica Home Care

Type of visit: Required - 1 Year

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Licensee Luis Lucero and administrator Jeffrey Gardner were notified via telephone and arrived later to assist. There are currently five residents in care, none of which are receiving hospice care at this time. Residents are observed relaxing in their respective bedrooms and in the common areas. LPA accompanied by facility staff toured the physical plant. The facility is a one-story house with one shared and three private bedrooms used by residents. There are two bathrooms used by residents. None of the residents are bedridden at this time. All occupied bedrooms appear clean and sanitary. All resident bedrooms have the required furnishings. Bathrooms appear clean and sanitary and are all equipped with grab bars and slip mats. Hot water temperature measured at 113F and 114F in two bathrooms with faucets used for personal grooming by residents. LPA observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items, cleaning supplies and the medication central storage are verified to be secure. Two wall-mounted fire extinguishers are present and verified to be charged with up-to-date maintenance indicated. Carbon monoxide and smoke detectors are present and operational. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 LPA and facility staff toured the outside of the facility. LPA observed a shaded outdoor seating area with outdoor furniture for resident use in the backyard. The identified routes of egress are free of clutter and obstructions. There are self-latching gates on both sides of the premises. Two sheds used for storage are present and observed to be locked. There are no bodies of water on the premises and the facility does not utilize either locked perimeters or delayed egress. LPA reviewed five resident records which were found to include all necessary elements of documentation. Consultation provided on medical assessments and admission agreements. LPA reviewed resident medication records and prescription orders with no discrepancies observed for three residents. LPA reviewed staff records for two staff members during the visit. All staff members on the schedule are background cleared and associated. Proof of current CPR training reviewed. Annual and initial training reviewed. Disaster drills are conducted quarterly. The administrator certificates are both current. Based on the observations conducted during the present visit, no deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted and a copy of this report were provided to a facility representative.the state’s words, verbatim · CDSS document, Jan 5, 2026

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: 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 8:46 AM, LPA Tea was greeted and granted entry into the facility by caregiver staff, Jibran Pina and explained the reason for the visit. Administrators (AD) Luis Lucero and Jeffrey Gardner arrived shortly to assist with the visit. Facility is licensed for 6 non-ambulatory residents, of which 1 may be bedridden in bedroom #4, with a hospice waiver for two. Currently there are five residents during today's visit. At 9:15 AM, LPA Tea reviewed five resident files and three staff files. Resident files contained all required documentation. Staff files had some discrepancies. AD Lucero’s certificate expires on July 18, 2025 and AD Gardner’s certificate expires on December 04, 2025. LPA Tea along with AD Gardener toured the facility at 10:07 AM. LPA toured the physical plant, checked food service, and the first aid kit. The home consists of 4 resident bedrooms, which one is shared, 2 full bathrooms, living room, dining room, and 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. During the tour a few toxins and medications were left unsecured, and staff immediately safely secured the products. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 117.3 F degrees and 113.5 F 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 bandages, dressing, tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked in a locked box on the kitchen counter. LPA observed toxin substances to be secured and locked and inaccessible to clients under the kitchen sink and garage. Annual Inspection continued on LIC809-C Fire extinguishers are fully charged. The facility’s last fire drill was conducted on December 14, 2024. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample seating with shade and the exit gates are self-latching and operational on both sides of the facility. LPA observed emergency food and water supply in the garage. Facility provides activities based on their preferences and physical limitations such as walking, playing with cards, and doing karaoke. At the time of the visit residents were having meals together and lounging and watching TV in the living room. At 10:39 AM LPA reviewed medication storage and administration. Medications are stored in a locked closet. Medications are being administered per physician order. LPA interviewed clients 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 administrators Luis Lucero and Jeffrey Gardner and a copy of this report LIC809, 809-C, LIC858, LIC859, LIC9102TV was read and provided to the facility.the state’s words, verbatim · CDSS document, Jan 10, 2025

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On June 6, 2024 at 10:55am, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Administrators (AD) Luis Lucero and Jeffrey Gardner and explained the purpose of the visit. The facility is licensed to operate for six (6) non-ambulatory of which one (1) may be bedridden and have a hospice waiver for two (2) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, two (2) bathrooms, living room, dining room, kitchen, and an outside covered patio area. LPA Kim toured indoor and outdoor of the physical plant with AD Lucero and AD Gardner. There are no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each client’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. All bedrooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Resident Room 4. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 116.7 degrees F and 117.1 degrees F. A comfortable temperature of degrees 76 degrees F was maintained in the facility. LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to clients. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. The facility has two (2) fire extinguishers that are charged, and smoke/carbon monoxide detectors were found operable. The facility conducted a Fire/Safety Drill on June 2, 2024 and are done quarterly. A working telephone (949-393-7100) remains available. First Aid Kit contained all the necessary elements. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices and plan of operation. LPA observed screening protocols for visitors, staff, and clients, and sanitizing station. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). LPA conducted an audit of resident files (R1-R5), staff files (S1-S5), and medication and medication administration review. LPA Kim conducted five (5) resident interviews and four (4) staff interviews. A LIC 9102 Advisory Notes: Technical Violation was issued for the PUB 475 poster not meeting regulation 20"x26". No deficiencies were cited during this inspection visit. An exit interview was conducted, and a copy of this report was provided to Administrator Luis Lucero and Administrator Jeffrey Gardner .the state’s words, verbatim · CDSS document, Jun 6, 2024

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.