Everlasting Home Care

Type of visit: Required - 1 Year

On 12/10/25 Licensing Program Analyst (LPA) Villegas conducted an unannounced visit to the above facility. LPA met with staff Maria..... as the purpose of the visit was explained. Facility is licensed to serve 6 ambulatory residents of which 6 may be non-ambulatory. The facility has an approved hospice waiver for 6. Facility fees info and pin were provided to staff (due date: 12/31/25 Balance: $495). Liability insurance is active (PC199445579-01 EXP: 01/22/26). The home is a single story home consisting of: (4) resident bedrooms, (1) full bathroom, 1 staff bathroom, den, living room, kitchen with dining area, laundry room (located in the attached garage), an outdoor shaded patio area, there are no bodies of water on the premises. A land line was observed. LPA toured the resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. The resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured between 105F- 120F.. Perishable and non-perishable food supply was checked, all cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were working properly, and fire extinguisher was fully charged. Emergency drill conducted on 12/09/25, first Aid kit and manual were available. LPA conducted a records review of (5) resident records, (5) resident Medication Administration Records, and (4) staff records. Exit interview conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 10, 2025

Type of visit: Office

On August 21, 2025, at 1:00 PM, an office meeting was held to discuss Complaint #11-AS-20220120114542. Present at the meeting were Janae Hammond, Licensing Program Manager (LPM); Zina Brown, Licensing Program Analyst (LPA); Kathrina Buller, Licensee Representative/Administrator. During the meeting, the LPM reviewed the details of the complaint. On March 16, 2024, the Department substantiated an allegation of neglect and lack of care and supervision, which resulted in a resident developing pressure injuries. At the time the findings were delivered on March 16, 2024, the Department indicated that an enhanced civil penalty determination was pending, pursuant to Health and Safety Code Section 1569.49(e), relating to Serious Bodily Injury. The Department is reviewing the complaint for enhanced civil penalty for serious bodily injury pursuant to H&S 1569.49(e). The total amount for the civil penalty totals $10,000 for Serious bodily injury. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 21, 2025

Allegation investigated: Resident sustained unexplained injuries while in care.

On 12/09/24, the department made an unannounced visit to the facility and was greeted by Staff #1 (S1: Maria Miclat). The department explained the purpose of today’s visit is to conduct a complaint investigation about the above-mentioned allegation. The department later was joined by the Administrator Buller Kathrina. The investigation consisted of the following: The department toured the residential care facility for the elderly (RCFE) and requested copies of the following pertinent documents: (1) A copy of the residents’ roster; (2) A copy of the staff roster; (3) Physicians’ Report for residents; (4) Resident Hospitalization Records; (5) Appraisal/Needs and Services Plans, thirty days’ notice, SIRs, and the Medication Administration Record (MAR) and Admission Agreement for R1. (Evaluation Report continues LIC 9099-C) Unsubstantiated Continued LIC9099-C Allegation: The resident sustained unexplained injuries while in care. Regarding the allegation resident sustained unexplained injuries while in care. It is alleged that the resident was admitted to Kaiser Permanente Medical Center for pneumonia and was observed to have various discolorations of unknown etiology (Mark) on the body. The department interviewed the Administrator #1 (A1) who stated that on 10/30/24, the Power of Attorney (POA), moved the resident #1 (R1) out of the facility and did not let A1 know where R1 would move. On 12/09/24, the department called and spoke to the (POA) over the phone who stated that POA remove R1 out of the facility due to medical necessity and personal reasons. The POA also stated that on 10/30/24, R1 did not have any discoloration or bruises on the body. The staff was very kind and took good care of R1 while residing at Everlasting Home Care. The hospitalization happened on 11/28/24, while R1 was at the new facility, The Villa. When the nurse observed R1, had pneumonia and called the paramedic who transported R1 to Kaiser Permanente Medical center and on the same day R1 was admitted. The department interviewed two residents (R2-R3) 2 out of 2 stated that they enjoyed living at the facility. The department interviewed two staff (S1-S2) 2 out of 2 stated that they do not restrain residents. The department interviewed the Independent Care Management Witness #1 (W1) who stated that W1 visits R1 twice a month at the facility and did not observe any discoloration or bruises on R1. Continued LIC9099-C Continued LIC9099-C According to W1, W1 stated that R1 is a very outspoken and would have let W1 know if any abuse happened. W1 also stated that R1 was on blood thinner that may have caused some discolorations to the body. The department records reviewed, dated 10/2024, revealed the resident left the facility a month before being admitted to Kaiser Permanente Medical Center. The department could not interview resident #4, #5, #6 due their cognitive ability. The department could not interview R1 because R1 was not available. Based on interviews, and record reviews, there is insufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or not occur, therefore the allegation is unsubstantiated. No deficiencies cited. Interview conducted. A copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Dec 9, 2024 · control 11-AS-20241203104040

Type of visit: Required - 1 Year

On 10/30/2024 at 12:10 PM, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one- year inspection. LPA met with Indu Amarasinghe, Administrator and the purpose of the visit was discussed. Facility is licensed to serve 6 non- ambulatory residents. Three (4) residents are diagnosed with dementia, (1) home health, (2) hospice care and (0) palliative care services. The facility does not handle any of the residents’ money. The home is a single story home consisting of: (4) resident bedrooms, (1) full bathroom, 1 staff bathroom, den, living room, kitchen with dining area, laundry room (located in the attached garage) and an outdoor shaded patio area. LPA toured the resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. The resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured at 116.9 F - 124.7 F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. LPA conducted a records review of (6) client records and (6) staff records reviewed the facility disaster plan. All client & Staff records were complete. The facility disaster plan was current and in compliance with Title 22 at the time of visit. LPA reviewed (6) Client Medication Administration Records and did not observed any discrepancies at the time of visit. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly, and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. During todays visit LPA did not observe any deficiencies. An exit interview was conducted with Indu Amarasinghe.the state’s words, verbatim · CDSS document, Oct 30, 2024

Allegation investigated: Staff neglect resulting in resident developing pressure injuries.

On 03/16/24, Licensing Program Analyst (LPA) Ernand Dabuet made an unannounced visit to the facility and was greeted by Staff #1 (S1: Maria Miclat). LPA conducted a risk assessment prior to entering the facility. S1 informed LPA that the facility has no COVID cases nor do any of the residents or staff have symptoms. The purpose for today’s visit is to conduct a subsequent visit and deliver the findings pertaining to the above-mentioned allegation. The investigation consisted of the following: An initial visit was conducted by LPA Troy Agard on 01/21/22 with Staff #1 (S1: Maria Miclat) for health & safety purposes of residents in care. LPA Agard toured the residential care facility for the elderly (RCFE) and requested copies of the following pertinent documents: (1) A copy of the residents’ roster (with responsible party); (2) A copy of the staff roster; (3) Physicians’ Report for all residents; (4) Appraisal/Needs and Services Plans for all residents; (Evaluation Report continues LIC 9099-C) Substantiated (5) Medication Administration Records (January 2022). Retired Annuitant (RA) Elizabeth Ceniceros reviewed pertinent documents: Admissions Agreement (dated 08/31/21), Emergency Identification & Information form (dated 08/29/21), Physician’s Report (dated 07/14/21), Wound Care Plan from Memorial Care Palliative Services (dated 01/03/22) with Visit Sign-in Sheet (between 10/07/21 – 01/17/22), Appraisal/Needs & Services Plan (dated 08/29/21), Medication Administration Record (January 2022), staff medication training (various dates), facility staff and residents’ rosters (January 2022). This complaint investigation was referred to the California Department of Social Services Investigations Bureau (IB) and was assigned to Investigator Dennis Seng which included a review of medical records (dated 01/17/22) from Memorial Care Hospital Palliative Care Unit; Memorial Care Palliative Care Progress Notes (dated 01/03/22); interviews conducted of hospital staff (Witness #1), hospice staff (Witness #2), Responsible Party for Resident #1 (Witness #3), former facility staff #2 (S2), current facility staff Administrator (A1), Staff #1 (S1), Staff #3 (S3), Resident #2 (R2), Resident #4 (R4). An attempt was made to interview Resident #3 (R3) but was unavailable. Resident #5 (R5) and Resident #6 (R6) could not be interviewed due to their cognitive impairment. Resident #1 passed away on 01/29/22 due to pneumonia. The investigation revealed the following: Regarding Allegation #1: Staff neglect resulting in resident developing pressure injuries. This investigation revealed that Resident #1 was admitted to the facility on 08/31/21. A review of the resident’s “Physician’s Report” documented under “Physical Health Status: No history of skin breakdown.” A review of Resident #1’s medical records (dated 01/17/22) from Memorial Care Hospital Palliative Care Unit documented Resident #1 was diagnosed with a Stage III (1.5cm x 1.5cm) pressure injury to the right heel on 01/05/22 and (again) on 01/10/22; Stage III (2cm x 2cm) pressure injury to back of right heel on 01/03/22; Stage III (2cm x 3cm) pressure injury to the right foot, back of heel on 12/31/22. Resident #1 had a wound care plan on file from Memorial Care Palliative Services (dated 01/03/22) and was receiving wound care for palliative services (effective 10/07/21) from Memorial Care Palliative Care based on their Progress Notes (dated 10/12/21, 10/21/21, 12/29/21, 12/31/21, 01/03/22, 01/05/22, 01/10/22, 01/17/22). Interview conducted of Witness #1 corroborated that Resident #1 suffered from respiratory failure, septic shock, and deep-pressure injuries; and Resident #1 was not admitted to Memorial Care Hospital Palliative Care Unit until 01/17/22 due to multiple Stage III deep-pressure injuries. (Evaluation Report continues LIC 9099-C) Resident #1 passed away on 01/29/22 due to pneumonia. Based on the evidence gathered and interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the allegation of NEGLECT/LACK OF SUPERVISION: Staff neglect resulting in resident developing pressure injuries is found to be SUBSTANTIATED. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the following deficiency has been observed and citation issued (ref. LIC 9099D). Civil penalties assessed. At this time, an enhanced civil penalty determination is pending in reference to Health & Safety Code 1569.49(e)(1)(A) entitled “Serious Bodily Injury” as defined in Section 243 of the Penal Code that states: “a serious physical condition; including, but not limited to, the following: loss of consciousness; concussion; bone fracture; protracted loss of impairment of any bodily member or organ; a wound requiring extensive suturing; and serious disfigurement”. An exit interview has been conducted and a copy of the Complaint Report and Appeal Rights were provided to the Staff #1 (Maria Miclat). (5) Medication Administration Records (January 2022). Retired Annuitant (RA) Elizabeth Ceniceros reviewed pertinent documents: Admissions Agreement (dated 08/31/21), Emergency Identification & Information form (dated 08/29/21), Physician’s Report (dated 07/14/21), Wound Care Plan from Memorial Care Palliative Services (dated 01/03/22) with Visit Sign-in Sheet (between 10/07/21 – 01/17/22), Appraisal/Needs & Services Plan (dated 08/29/21), Medication Administration Record (January 2022), staff medication training (various dates), facility staff and residents’ rosters (January 2022). This complaint investigation was referred to the California Department of Social Services Investigations Bureau (IB) and was assigned to Investigator Dennis Seng which included a review of medical records (dated 01/17/22) from Memorial Care Hospital Palliative Care Unit; Memorial Care Palliative Care Progress Notes (dated 01/03/22); interviews conducted of hospital staff (Witness #1), hospice staff (Witness #2), Responsible Party for Resident #1 (Witness #3), former facility staff #2 (S2), current facility staff Administrator (A1), Staff #1 (S1), Staff #3 (S3), Resident #2 (R2), Resident #4 (R4). An attempt was made an attempt to interview Resident #3 (R3) but was unavailable. Resident #5 (R5) and Resident #6 (R6) could not be interviewed due to their cognitive impairment. Resident #1 was not interviewed due to hospitalization on 01/17/22 and later passed away on 01/29/22 due to pneumonia. The investigation revealed the following: Regarding Allegation #2: this investigation revealed following a review of Resident #1’s “Physician’s Report” (dated 07/14/21) documented under “Capacity for Self-Care” the resident is “able to feed self”. A review of Resident #1’s “Appraisal/Needs and Services Plan” (dated 08/29/21) documented under “Needs – Method of Evaluating Progress: resident will be monitored daily of any decline.” Interviews conducted of staff (S1, S2, S3) corroborated that facility staff were properly caring (encouraging water intake) for Resident #1. Resident #1 had an 8 oz water cup that was provided during mealtimes including juice. An attempt was made to interview Resident #3 (R3) but was unavailable. Resident #5 (R5) and Resident #6 (R6) could not be interviewed due to their cognitive impairment. Resident #1 was not interviewed due to hospitalization on 01/17/22 and later passed away on 01/29/22 due to pneumonia. (Evaluation Report continues LIC 9099-C) Based on the evidence gathered and interviews conducted and records reviewed, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation of PERSONAL RIGHTS: Staff not properly caring for resident resulting in resident becoming dehydrated is found to be UNSUBSTANTIATED. Regarding Allegation #3: this investigation revealed based on interviews conducted of staff (S1, S2, S3) corroborated that facility staff were properly caring (food intake) for Resident #1. Facility staff had to spoon feed the resident and observe the resident consume their food due to the resident’s diagnosis. An attempt was made to interview Resident #3 (R3) but was unavailable. Resident #5 (R5) and Resident #6 (R6) could not be interviewed due to their cognitive impairment. Resident #1 was not interviewed due to hospitalization on 01/17/22 and later passed away on 01/29/22 due to pneumonia. A review of Resident #1’s “Physician’s Report” (dated 07/14/21) documented under “Capacity for Self-Care” the resident is “able to feed self”. A review of Resident #1’s “Appraisal/Needs and Services Plan” (dated 08/29/21) documented under “Needs – Method of Evaluating Progress: resident will be monitored daily of any decline.” Based on the evidence gathered and interviews conducted, and records reviewed, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation of PERSONAL RIGHTS: Staff did not ensure resident is consuming food is found to be UNSUBSTANTIATED. Regarding Allegation #4: this investigation revealed based on interviews conducted of staff (S1, S2, S3) corroborated that facility staff did not encourage Resident #1 to stay in bed; as the resident would be sitting in a recliner with their leg on top of a chair with their feet up so as not to place pressure on their wounds. A review of the resident’s Memorial Care Palliative Services Care Plan (dated 01/03/22) with Visit Sign-in Sheet (between 10/07/21 – 01/17/22) documented Witness #2 was observed “awake and sitting in a chair (recliner) or wheelchair”. Resident #1 was not interviewed due to their hospitalization on 01/17/22. An attempt was made to interview Resident #3 (R3) but was unavailable. Resident #5 (R5) and Resident #6 (R6) could not be interviewed due to their cognitive impairment. A review of Resident #1’s “Physician’s Report” (dated 07/14/21) documented under “Physical Health Status: Fair. No history of skin breakdown, ambulatory, and does not require bed care.” Under “Ambulatory Status: This person can independently transfer to and from bed. This person is considered ambulatory.” (Evaluation Report continues LIC 9099-C) Based on the evidence gathered and interviews conducted, and records reviewed, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation of PERSONAL RIGHTS: Staff encourages resident to stay in bed is found to be UNSUBSTANTIATED. Regarding Allegation #5: this investigation revealed based on interviews conducted of staff (S1, S2, S3) corroborated that facility staff administered Resident #1’s medications per physician’s order(s) and not administered with medications to sedate the resident. A review of Resident #1’s “Physician’s Report” (dated 07/14/21) documented under “Medication Management” that resident cannot administer own medications. A review of the Resident 1’s Medication Administration Record (dated January 2022) documented physician’s medication orders under “Treatment/Medication (type and dosage)” were administered by facility staff who had signed their initials following the administering of resident’s medications. Resident #1’s medications were audited with the MAR and no documentation of medication for sedation was observed to have been administered between the month of December 2022 thru January 16, 2022. Resident #1 was hospitalized on 01/17/22. Based on the evidence gathered, interviews conducted, and records reviewed, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation of MEDICATIONS: Staff administering medications to resident without consent is found to be UNSUBSTANTIATED. An exit interview has been conducted and a copy of the Complaint Report was provided to the Staff #1 (Maria Miclat).the state’s words, verbatim · CDSS document, Mar 16, 2024 · control 11-AS-20220120114542

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: Mar 17, 2024

Prohibited Health Conditions (a) Persons who require health services or have a health condition including but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure sores (dermal ulcers). This requirement is not met as evidenced by: A review of medical records (dated 01/17/22) from Memorial Care Hospital Palliative Care Unit documented Resident and was diagnosed with a Stage III (2cm x 3cm) pressure injury to the right foot, back of heel on 12/31/22; Stage III (2cm x 2cm) pressure injury to back of right heel on 01/03/22; and Stage III (1.5cm x 1.5cm) pressure injury to the right heel on 01/05/22 and (again) on 01/10/22; and, facility staff failed to take the resident to the hospital until 01/17/22. This violation which posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 16, 2024

Plan of correction: Licensee/Administrator shall read Title 22, Section 87615(a)(1) entitled, "Prohibited Health Conditions" and submit a written statement that they will ensure to stay in constant communication with the medical professional(s); and, if the resident's medical condition elevates - meaning the resident requires a higher level of care, Licensee/Administrator will ensure the resident is relocated to a hospital or skilled-nursing facility and the relocation will take place immediately. Because Administrator retained Resident #1 at the facility from 01/03/22 until the resident’s hospitalization on 01/17/22 with multiple Stage III pressure injuries that required a higher level of care, a civil penalty is being assessed in the amount of Five-hundred Dollars ($500) for retaining the resident with a prohibited health condition. This plan of correction (POC) is due to CCLD/El Segundo ASC Office no later than the POC due date on 03/17/24 to Elizabeth.Ceniceros@dss.ca.gov.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(c)(4) · Plan of correction due date: Mar 17, 2024

Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety, and health care needs as identified in their current appraisal. This requirement is not met as evidenced by: Resident #1 sustained multiple deep pressure injuries while living at the facility (between 01/03/22 and 01/17/22) until facility staff had the resident transported to Memorial Care Hospital Palliative Care Unit. This violation which posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 16, 2024

Plan of correction: Licensee/Administrator shall read Title 22, Section 87705(c)(4) entitled, “Care of Persons with Dementia” and submit a written statement. This plan of correction (POC) is due to CCLD/El Segundo ASC Office no later than the POC due date on 03/17/24 to Elizabeth.Ceniceros@dss.ca.gov.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Mar 17, 2024

Observation of the Resident: The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional, and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Resident #1 was diagnosed with a Stage III (2cm x 3cm) pressure injury to the right foot, back of heel on 12/31/22; Stage III (2cm x 2cm) pressure injury to back of right heel on 01/03/22; Stage III (1.5cm x 1.5cm) pressure injury to the right heel on 01/05/22 and (again) on 01/10/22; and, the resident was not taken to the hospital until 01/17/22. This violation which posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 16, 2024

Plan of correction: Licensee/Administrator shall read Title 22, Section 87466 entitled, “Observation of the Resident” and submit a written statement. This plan of correction (POC) is due to CCLD/El Segundo ASC Office no later than the POC due date on 03/17/24 to Elizabeth.Ceniceros@dss.ca.gov.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(d)(1) · Plan of correction due date: Mar 30, 2024

Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (1) Knowledge of the requirements for providing care and supervision appropriate to the residents. This requirement is not met as evidenced by: Facility retained Resident #1 knowing the resident suffered from multiple deep pressure injuries that were diagnosed a Stage III upon hospitalization at Memorial Care Hospital Palliative Care Unit on 01/17/22. This violation which posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 16, 2024

Plan of correction: Licensee/Administrator agreed to comply and review Title 22 Section 87405(d)(1) entitled, “Administrator – Qualifications and Duties” and implement a plan to ensure that the resident(s) is/are regularly observed for changes and appropriate assistance is provided to the resident(s). Licensee/Administrator agreed to submit a written statement to CCLD/El Segundo ASC Office no later than the POC due date on 03/30/24 to Elizabeth.Ceniceros@dss.ca.gov.

Type of visit: Required - 1 Year

On 12/21/2023 at 08:30 AM, Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced annual inspection visit at the Everlasting Home Care Facility. LPA Calderon was allowed entry into the facility by Staff Maria Miclat. Staff Maria Miclat asked infection control questions and took LPA Calderon temperature prior to entrance into the facility. The facility is licensed for six (6) adult clients 59 year or older. Currently, there are six (6) residents residing in the facility 59 years or older. LPA Calderon explained to Staff Maria Miclat, the purpose of the one-year Annual Inspection visit, and escorted LPA Calderon on a tour of the entire inside and outside facility grounds. As part of the inspection, LPA Calderon reviewed: Six (6) resident service records, six (6) resident medication records, two (2) staff records, and inspected the inside facility and outside grounds. LPA Calderon interviewed six (6) residents and two (2) staff members for visit. The facilities’ last fire drill was conducted on 08/17/2023. The one-story residential home consists of (4) resident bedrooms, (2) resident bathrooms, living room, dining room, family room, kitchen, office area, attached garage with washer and dryer/ storage area, backyard with table and chairs. No weapons are stored in the premises. Kitchen was inspected and observed to be clean and operational. A two-day supply perishable and seven-day supply of non-perishable foods are present in the facility. Emergency Water supply is found in a storage closet. LPA Calderon observed that all facility rooms are clean and in good repair. A comfortable temperature was observed, and the facility has central air and heating. LPA Calderon observed the following during inspection of resident’s rooms: mattresses are in good condition, adequate lighting present, plenty of dresser/closet space is present, and all bed linens present. All bedrooms contain furniture, lighting fixtures and personal storage space as required, all beds have the required amount of linen and mattress covers, LPA Calderon observed fully stocked closet with bedding, towels, and toiletries supplies. Bathroom fixtures are clean, in good repair, and working properly and contain the required nonskid mats and grab bars. LPA Calderon observed bathrooms were found to be within Title 22 regulation. Bathroom #1 hot water temperature properly measured at 113 degrees Fahrenheit, and bathroom #2 hot water temperature properly measured at 112 degrees Fahrenheit. Kitchen hot water temperature properly measured at 114 degrees Fahrenheit. Facility (2) carbon Monoxide and (7) Smoke Detectors hard wired and connected were tested and are working properly. The facility (2) Fire Extinguishers were checked and found to be fully charged and accessible. All exit doors in the facility have alarm systems. All toxins and knifes are locked/secured and inaccessible to residents. Medications are centrally stored and in a locked storage cabinet. Facility 2 first aid kit is fully stocked with manual was checked and in order. Outside grounds were toured and no bodies of water were observed. All Exits/ Walkways around the home were free of debris and hazards. Outside patio accessible to residents. LPA Calderon reviewed six (6) resident medications and they were all found to be administered according to doctor's orders. LPA Calderon noted the Administrator Kathrina P Buller Certification # 6042683740 expiration date of 10/30/2024 was valid at time of visit. The facility does NOT handle resident's money/cash resources and NO Surety bond is needed. Commercial General Liability Policy #PCI3397484501 policy period from 01/22/2023 to 01/22/2024 underwritten by Primary Care Insurance Company, coverage 1,000,000/3,000,000 is valid at time of inspection. All the required documents are posted in the facility in a clearly visible area. During the visit, LPA Calderon observed the facility infection control practices. LPA Calderon observed screening protocols for visitors, staff, and residents, sanitizing stations (Located in common areas and restrooms). LPA Calderon observed staff and residents were NOT wearing face coverings and required postings throughout the facility. LPA Calderon observed the facility has a thirty-day supply of Personal Protective Equipment (PPE). LPA Calderon advised the Staff Maria Miclat to continuously monitor the Centers for Disease Control (CDC) website and Community Care Likening Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA Calderon did not observe any deficiencies therefore NO citations were issued at this time. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Staff Maria Miclat.the state’s words, verbatim · CDSS document, Dec 21, 2023