Southbay Maxi Care

Type of visit: Required - 1 Year

At 8:00am on 01/12/2025, Licensing Program Analyst (LPA) Jeffries arrived to the facility unannounced to conduct the annual facility inspection. LPA met with Licensee/Administrator Lita Lazo announced who he is and the reason for the visit. LPA noted that this is a 7 bedroom, 3 bathroom, single resident occupancy bedrooms and 1 staff room (room#5), there are 2 living rooms, a dining room, kitchen and laundry room. the garage is a converted storage area. There is seating and shade both in the back yard and the front yard with shade for resident activities and visitations. LPA noted that each room has proper furnishing, linins, and lighting. LPA noted that the bathrooms have liquid soap and paper towels and water temperature tested throughout the facility is within regulation permitters of 105*-120*(f). LPA observed at least 2 days of perishable foods and 7 days of non permeable foods on hand for at least 6 residents and staff. LPA discovered expired food in the freezer and noted a "rotting" smell in the dining room. Citation and civil penalty issue for repeat violation for less than 12 months (87555(b)(8)). LPA noted that the emergency water supply is located in the garage storage area. LPA noted that the medications are locked in the dining room and there is a complete first aide kit also located with the medications. LPA noted that there are smoke detectors located throughout the facility and carbon monoxide detector is located in kitchen doorway. LPA noted that the facility is clean and in good repair. LPA observed fire extinguishers primed and in the green and currently tagged as working. LPA observe all door ways and passage ways to be free and clear of obstacle. LPA noted that required postings are in the kitchen and hallways of the facility. LPA conducted a review of Emergency Disaster Plan, Infection Control Plan, Staff and Resident Files and a cursory review of Centrally Stored Medication Records (CSMR). Administrator/Licensee and LPA conducted a full review of the annual care tools module and noted one violation and civil penalty issued for repeat violation with in 12 months. Exit interview, report read, violation and civil penalty issued, appeal rights and report provided.the state’s words, verbatim · CDSS document, Jan 12, 2026

Allegation investigated: Licensee did not ensure residents were provided food of good quality.

At 7:30am on 04/11/2025, Licensing Program Analyst (LPA) Jeffries arrived unannounced at the facility to conduct the initial investigation visit to the allegation to this complaint. LPA met with Administrator, Lita Lazo announce who he is and the reason for the visit. LPA conducted interviews, conducted a physical tour of the facility focusing on the kitchen and food supply. LPA made observations and took photographs. LPA requested documentation to support the final finding of the allegation to this complaint that were issued on this visit. As to the allegation of, “Licensee did not ensure residents were provided food of good quality.” It was alleged that in the late morning of 04/08/2025, a reliable witness (a person with license or credentials indicating expertise training and/or experience) observed, “a handful of rotting, shriveled carrots with brown spots and one rotting squash.” a photograph of said vegetables was provided. It was discovered on 04/11/2025 that Licensing Program Analyst (LPA) Jeffries conducted an interview with Administrator Lida Lazo (S1) on 04/11/2025, who stated, "need to clean the kitchen refrigerator/(frezer) of all bad food." CONTINUED on LIC9099-C Substantiated On 04/11/2025 LPA Jeffries observed undistinguishable fruit (could have been Pears or Apples) that were in a plastic bag and rotting. LPA observed a full container of Sprouts Organic Vanilla Oatmilk with a sale date of 06/21/2023 that were in the kitchen refrigerator; LPA observed several frozen meats with sell by dates that were over 1 year old in the kitchen freezer. Based on a reliable W1 observation and photographs, LPAs observation, photographs and interviews there is enough evidence at this time to support the allegation of, “Licensee did not ensure residents were provided food of good quality.” And is substantiated at this time. Exit interview, report read, citation issued, appeal rights and report provided.the state’s words, verbatim · CDSS document, Apr 11, 2025 · control 29-AS-20250410114231

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(8)(9) · Plan of correction due date: Apr 25, 2025

87555 General Food Service...(b) The following food service requirements shall apply...(8)All food shall be of good quality...Food in damaged containers shall not be accepted, used or retained.(9) Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. This requirement was not met by evidence of W1 observations/photographs and LPA's observation and photographs, which puts residents in potential danger.the state’s words, verbatim · CDSS document, Apr 11, 2025

Plan of correction: licensee Lida Lazo will inventory every food item is the kitchen refrigerator/freezer and discard all food with dates older than 2024 on the sell by tag, all foods damaged and or rotting and provided covered container for all loose foods. Administrator will email or text pictures of refrigerator/frezzier once per for the next 4 weeks to ensure quality food has replaced discarded food. Admin. will also provide grocery receipts for the next 4 weeks by email or photo text to LPA.

Allegation investigated: Licensee did not provide a refund to resident's responsible person

On 12/17/24 at 9:45 am, Licensing Program Analyst (LPA) Rankin conducted an unannounced complaint visit to the facility above to review allegations of complaint. LPA met with Administrator Lita Lazo and explained the purpose of the visit. On the allegations: Licensee did not provide a refund to resident's responsible person It was alleged by the reporting party that the licensee failed to refund the pro-rated amount of the monthly payment after the passing of Resident #1 (R1). Investigation consists of facility admission agreement with resident, interview with administrator and responsible person. LPA learned that R1 moved in in June of 2021 and passed away on 05/08/24. Interviews revealed that resident’s belongings were removed the same day on 05/08/24 by responsible party and 2 witnesses. Substantiated Continued from 9099 Resident’s admission agreement states that “refund is based on the number of unused days. Refund to be issued within ten (10) days from the last day of either stay or when all belongings are removed from the facility.” Resident #’1’s rent for the month of May 2024 was paid in full at the beginning of month. Refund was requested however administrator/licensee failed to issue refund. Per Admission agreement and Health and Safety Code 1569.652 (c) “A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed.” Facility administrator failed to refund the pro-rated amount of the monthly rent, 05/08/24 to 05/31/24, to R1's responsible party within the required time frame required by California State law. Therefore, the allegation " Licensee did not provide a refund to resident's responsible person " is deemed substantiated. Exit interview conducted, citations, copy of report and appeal rights issued.the state’s words, verbatim · CDSS document, Dec 17, 2024 · control 29-AS-20241210132533

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Dec 31, 2024

1569.652 Termination of admission agreement upon death of resident...(c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued...within 15 days after the personal property is removed. This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above. Licensee failed to provide R1’s Representative with a refund within 15 days after R1 passed away and personal belongings removed, which posed a potential health, safety, or personal rights to residents in care.the state’s words, verbatim · CDSS document, Dec 17, 2024

Plan of correction: Administrator will ensure a refund is sent to R1’s family by 12/31/24 and send evidence of the payment via email to LPA.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rankin arrived at 09:45 am to conduct a 1 year annual visit to the facility above. LPA met with Administrator Lita Lazo and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Physical Plant & Environment Safety: The fire extinguishers were last charged and inspected on 11/4/24. The facility has 6 resident bedrooms, 1 staff bedroom and 3 bathrooms currently occupying 4 residents. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors which were tested and working at the time of visit. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety and lighting is sufficient for resident’s comfort. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care and locked under sink and garage. The facility has sufficient space inside and outside for activities and visiting. The facility has a fenced backyard for client use with plenty of shade. The facility has telephone and internet service for resident use. Operational Requirements: The facility has a current plan of operation on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 8/1/25. The facility is approved for a capacity of 6. The fire clearance is granted for 6 Non-Ambulatory of which 1 may be bedridden. Hospice is approved for 3. Staffing: The facility currently employes 2 full-time live-in staff and 2 Administrators. Licensee has two facilities and employs 21 staff that can be used for back up staffing if needed. Continued 809-C File of two full time staff reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions. One Administrator Certificate expires 5/14/25 and one administrator is currently pending renewal. Staff have annual training completed for all subjects/topics and hours for 2024. Resident Records & Incident Reports: The facility keeps separate files on each resident. Facility does submit incident reports to the department when required. LPA reviewed 4 resident files, same residents were reviewed last annual visit, LPA looked for updated LIC. 602A Physicians report, and updated Appraisals Needs and Services Plan, all forms were updated in December of 2024, legible, and records are kept confidential. Food Service: The facility handles and prepares food safely. The facility has 2-day perishables and 7 day non-perishables to meet the food service requirement. All food is covered, stored and marked appropriately. Food, snacks and drinks are available when the residents want them. Cleaning solutions and equipment are stored separately from food supplies. Facility had extra items in the freezer that will be cleaned and rotated. Incidental Medical Services: Facility provides transportation or assists in providing transportation to medical and dental appointments when needed. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed residents’ medications, no labels were altered, no medications were expired, and all medications were kept in their original containers. Sampling of medication was reviewed for record keeping and count accuracy. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts quarterly disaster drills. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility has 2 gates on side of the home, both gates need self-closing feature updated, but both self-latch and are well maintained and functional for staff and emergency personnel. Facility does not currently have anyone on oxygen. The facility currently has no hospice resident in care. The facility does not currently have any residents receiving Home Health services. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Dec 17, 2024

The state marks this report as 6 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

Licensing Program Analyst (LPA's) Miller and De Leon arrived at 10:55 am to conduct a 1 year annual visit to the facility above. LPAs met with Administrator Lita Lazo and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Infection Control: The facility has a current Infection Control Plan. The facility has a sign in and out binder for visitors at entry with hand sanitizer. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. The facility has EPA approved disinfectant spray and cleaners. The facility has a 30 day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). The window blinds throughout the facility need to be cleaned. All trash cans and wastebaskets have tight fitting covers. The bathroom walls need cleaning as well as dusting of cobwebs, spiders and ants. Physical Plant & Environment Safety: The kitchen cabinets and ceiling near the stove need cleaning due to grease splatter. The fire extinguishers were last charged and inspected on October 28, 2022. They are charged, but Administrator called to have extinguishers re-tagged. The facility has 6 resident bedrooms, 1 staff bedroom and 3 bathrooms currently occupying 5 residenst and employs 2 full time live in staff. and 2 Administrators. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors. The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The showers have non-skid mats. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care and locked under sink and locked garage. The facility has sufficient space inside and outside for activities and visiting. The facility has an fenced backyard for client use with plenty of shade. The facility has telephone and internet service for resident use. Continued 809-C Operational Requirements: The facility has a current plan of operation on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on August 1, 2024. The facility is approved for a capacity of 6. The fire clearance is granted for 6 Non-Ambulatory of which 1 may be bedridden in bedroom #7. Hospice is approved for 3. Staffing: The facility currently employes 2 full time live in staff and 2 Administrators. Licensee has two facilities and employs 21 staff that can be used for back up staffing if needed, Staff records are kept confidential. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Finger print clearance/Associations/exemptions. Administrator file was reviewed for Continuing Education requirements and current Administrator Certificate. One Administrator Certificate expires May 14, 2025 and one administrator is currently pending renewal. Personnel Records & Training: The facility keeps confidential files for each staff member. Staff have annual training completed for all subjects/topics and hours for 2023. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed 5 resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, LIC. 602A Physicians report, Pre-appraisals, Appraisals Needs and Services Plan, Emergency and ID forms, all forms were legible and records are kept confidential. Food Service: The facility handles and prepares food safely. The facility has 2 day perishables and 7 day non-perishables to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored and marked appropriately. Food, snacks and drinks are available when the residents want them. Cleaning solutions and equipment are stored separately from food supplies. Kitchen areas needed additional cleaning of grease around the stove area and cupboards. Kitchen staff are observed for personal hygiene and food sanitation practices. Continued 809-C Incidental Medical Services: Facility provides transportation or assists in providing transportation to medical and dental appointments when needed. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed residents medications, no labels were altered, no medications were expired and all medications were kept in their original containers. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts quarterly disaster drills. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility has 2 gates on side of the home, 1 gate is in need of repair due to latch rusted and will no longer open and close and 1 gate is no longer self latching and in need of repair. One independent resident had over the counter medications and a pair of scissors in her bathroom cupboard. Administrator immediately took and locked away. Facility does not currently have anyone on oxygen . The facility currently has 1 hospice resident in care. The facility does not currently have any residents receiving Home Health services. The facility does not have delayed egress, locked doors or gates. Exit door alarms are working. Interview conducted with Administrator - Unable to conduct interviews with residents. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Jan 3, 2024

The state marks this report as 9 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.