Fil-Am Home for Seniors: Lansing's

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced required annual visit using the Compliance and Regulatory Enforcement (CARE) Tool. LPA was greeted by Joann Hernandez, Caregiver and explained the reason for the visit. Max Raharuhi, Administrator Assistant arrived shortly thereafter. The facility is licensed to serve residents ages sixty (60) and older. The approved capacity is six (6) non-ambulatory residents. The facility is approved to retain no more than four (4) residents receiving hospice care. There were four (4) residents under hospice care during inspection and two (2) residents receiving home health. Facility Tour & Observations Personal Rights postings (LIC 613C and Ombudsman), Complaint Poster (PUB 475), and nondiscrimination notice were observed in a common area. Oxygen was observed in use in the facility. Required “Oxygen in Use / No Smoking” signs were posted throughout the facility in visible locations. Residents had access to personal space, privacy, and adequate storage. No firearms/weapons were present. Physical Plant The facility is in a residential area and is a one-story home consisting of six (6) resident bedrooms, two (2) restrooms with one being a private restroom, living room/dining area, kitchen, laundry room, garage, front yard, and backyard w/a gated pool. LPA observed six (6) resident bedrooms, and all contained the required furniture (bed, mattress, linens, dresser, chair, and lighting). (continued 809C) Cleaning supplies and toxic substances were accessible to residents in a kitchen cabinet under sink. Bathrooms were clean and equipped with required grab bars in showers and near toilets, as well as non-skid mats; hot water measured in bathroom (1) 105.2°F and bathroom (2)105.3 which is within the required 105–120°F. Extra linens and towels were available in a hallway cabinet. Smoke/carbon monoxide detectors were functional; fire extinguisher available by front entrance and dining room area. Backyard provided shaded seating. Passageways and exits were observed to be clear and unobstructed. Food Service Refrigerators/freezers were maintained at proper temperatures (refrigerators maximum of 40 degrees °F and freezer 0-degree °C) with sufficient supply of 2-day perishable and 7 days non-perishable food. Fresh produce, proteins, and dry goods were stocked. Knives and were observed in a locked kitchen drawer. Health-Related Services & Records Six (6) resident files (R1–R6) were reviewed. All six (6) files were missing Annual Appraisals. Five (5) residents had current Admission Agreements; however, R5 did not have an Admission Agreement on file. Pre-Placement Appraisals were complete for four (4) residents; R5 and R6 had incomplete or missing Pre-Placement Appraisals. Consents, Needs/Service Plans, and Physician’s Reports documenting TB clearance and ambulatory status were present for three (3) residents. Residents R3, R5, and R6 did not have TB test results on file; additionally, R5 did not have a Physician’s Report. Resident Rights acknowledgments were present for all residents. Three (3) residents’ medications were reviewed and observed to be centrally stored in a locked kitchen cabinet. Medication Administration Records (MARs) were current. Disaster Preparedness Last fire/earthquake drill was conducted on November 26, 2025, with logs available. LIC 610D Emergency Disaster Plan was posted on kitchen bulletin board. Emergency supplies (water, food, flashlights, batteries, first aid) were observed in the garage. Infection Control Plan was updated. Personnel Records & Training Four (4) staff files were reviewed and included criminal record clearances. CPR/First Aid certificates were missing for two (2) staff members (S1 and S3). TB screenings were missing for three (3) staff members (S2, S3, and S4). Required training documentation was reviewed and present. Insurance Liability insurance was in compliance with an expiration date of April 5, 2026. An exit interview was conducted with Toby Miclat, Administrator. During the inspection, deficiencies were observed and cited on the attached LIC 809D/809C in accordance with Title 22, Division 6 regulations. A copy of this report, LIC 809D/809C and Appeal Rights was provided via email.the state’s words, verbatim · CDSS document, Jan 16, 2026

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced required annual inspection visit and was greeted by Administrator Lea Loaiza. Administrator Toby Miclat arrived shortly after. LPA Ramirez explained the purpose of the visit. The facility is located on a residential and is a single store dwelling. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Physical Plant and Environment safety: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be inaccessible to residents. Carbon monoxide detectors and smoke alarms in hallways were tested and operational. LPA Ramirez inspected six (6) resident rooms. All resident bedrooms contained required furniture, linens, and lighting. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. LPA Ramirez observed grab bars near toilets and inside showers. LPA Ramirez observed no-slip mat in showers. Bathroom#1 has a wheelchair accessible shower. Food Service: LPA Ramirez observed sufficient supply of nonperishables for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean and within temperatures of 0-degree F (-17.7 degree C), and refrigerators with maximum temperature of 40-degree F. (4 degree C). Planned Activities: LPA Ramirez observed board games, magazines, and other activities for residents. Residents Rights-Information: LPA Ramirez observed the following postings in common areas throughout the facility: Complaint Poster (PUB 475), personal rights, and nondiscrimination notice. LPA Ramirez observed facility land line. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. Last documented emergency drills were conducted on 01/02/2025. LPA Ramirez observed facility sketches with exits and emergency exits routes throughout various locations of the facility. LPA Ramirez observed emergency food supply located in pantry. See 809-C Residents with Special Needs: Pool was observed to contain locked gate around perimeter. LPA Ramirez observed signs posted indicating “No smoking - Oxygen in Use” in various locations of the facility. LPA Ramirez observed several oxygen tanks in resident rooms secured in stands. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. Auditory devices were observed to be in working order. Health Related Services/Incidental Medical Services: Medications are centrally stored in locked kitchen cabinet and in bubble packs and/or original containers. The facility uses electronic charting to document medications administered and other charting notes on residents. The facility provides incidental medical services. Staffing: Administrator Certificate for Toby Miclat expires 10/12/2025. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Personnel Records Training: Staff files are maintained at the facility. LPA Ramirez observed required annual training, CPR and First Aid for two (2) out of the two (2) personnel records reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for two (2) out of the two (2) personnel records reviewed. Infection Control: Staff is using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place. LPA Ramirez observed staff wearing gloves while proving care to a resident. Operational Requirements: The fire clearance is approved for six (6) non-ambulatory. This facility may retain no more than four (4) hospice residents. There were four (four) residents under hospice care during inspection. Resident Records/Incident Reports: LPA reviewed Resident files for six (6) residents in care. Resident files are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, Resident Rights were observed. No deficiencies were observed during this visit. Exit interview conducted. A copy of this report was provided via email.the state’s words, verbatim · CDSS document, Feb 20, 2025

Allegation investigated: Resident developed pressure injuries in care. Facility staff are not repositioning the resident as needed. Facility staff are not meeting incontinence care needs of resident. Facility staff speak inappropriately to resident.

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 01/28/2025, to deliver findings. Initial complaint investigation visit was conducted by LPA Ramirez on 12/24/2024 and needs further investigation was documented. LPA Ramirez was met by Back-up Administrator Lea Loaiza and explained the purpose of today’s visit. The investigation consisted of the following: LPA Ramirez requested and obtained copies of Personnel Report (LIC 500), Resident Roster, Staff#1-2 interviews (S1-S2), Resident interviews#1- 4 interviews (R1 – R4), Interview of R1’s responsible party, Resident#1- (R1): Emergency Contact Form, Physician Report, Centrally Stored Medication and Destruction Record (LIC 622), Resident Appraisal (LIC 603A), and physical plant tour. See 9099-C for continued report. Unsubstantiated The investigation revealed the following. Regarding Allegation(s): Resident developed pressure injuries in care - It is alleged R1 developed pressure injuries while receiving care at the facility. Two (2) out of the two (2) staff interviewed denied this allegation. Three (3) out of the four (4) residents interviewed denied this allegation. Interview with R1’s responsible party denied this allegation. Physicians report (LIC 602A) dated 1/15/2025, revealed R1’s physician observed R1’s skin integrity to be normal and clear. R1’s physician did not observe bedsores or abrasions. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Facility staff are not repositioning the resident as needed - It is alleged that staff are not repositioning R1 as needed. Two (2) out of the two (2) staff interviewed denied this allegation. Three (3) out of the four (4) residents interviewed denied this allegation. Interview with R1’s responsible party denied this allegation. LPA Ramirez reviewed R1’s resident records including R1’s physician orders. LPA Ramirez did not observe a physician’s order indicating staff shall reposition R1. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Facility staff are not meeting incontinence care needs of resident- It is alleged staff leave R1 soiled. Two (2) out of the two (2) staff interviewed denied this allegation. Three (3) out of the four (4) residents interviewed denied this allegation. Interview with R1’s responsible party denied this allegation. During facility tour, LPA Ramirez observed six (6) out of the six (6) residents to be well groomed and residents’ rooms were not observed to be malodorous. LPA Ramirez observed all resident beds to contain disposable incontinence pads and required linens. LPA Ramirez observed the facility to have sufficient supply of incontinence care products. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Facility staff speak inappropriately to resident – It is alleged staff spoke inappropriately to R1. Two (2) out of the two (2) staff interviewed denied this allegation. Three (3) out of the four (4) residents interviewed denied this allegation. Interview with R1’s responsible party denied this allegation. During tour of facility, LPA Ramirez observed staff providing care and supervision. LPA Ramirez observed staff to be professional and did not observe staff speaking inappropriately to residents. Staff interviewed were knowledgeable on residents’ rights and on specific needs of the residents’ they serve. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No deficiencies were cited during this investigation. Exit interview conducted. A copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 28, 2025 · control 28-AS-20241218160327

Allegation investigated: Facility failed to provide a safe environment for a resident in care

This report supersedes the previous complaint reports dated 04/09/24 and 05/02/24. The reason it’s being superseded is to provide additional information not included on the original LIC9099 dated 04/09/24 and 05/02/24, and to remove the LIC 9099D for the citation which was issued erroneously.The findings will remain the same. On today's visit Licensing Program Analyst (LPA) Sanjay Vaid and Licensing Program Manager (LPM) Fernando Fierros conducted a tour of the physical plant along with caregiver Joanne Hernandez, and obtained staff and resident roster. All passages are clear of debris, facility is clean and in good repair. On 05/02/24, Licensing Program Analyst (LPA) Sanjay Vaid conducted a subsequent visit and met with staff Joanne Hernandez and staff Mark Reyes, staff notified the Administrator of Licensing's visit. 30 minutes later, Administrator, Lea Loaiza and Licensee,Toby Miclat arrived at the facility and the purpose of the visit was discussed. LPA and staff Hernandez toured the physical plant and observed the facility to be clean, in good condition, and free of obstacles throughout. LPA Vaid conducted interviews with residents. Unsubstantiated On 04/09/24, Licensing Program Analyst (LPA) Sanjay Vaid and Tyler Reyes conducted a subsequent complaint visit regarding the allegation listed above to deliver complaint investigation findings. LPA Vaid and Reyes met with licensee-Toby Miclat and administrator- Lea Loaiza and discussed the purpose of the visit, which was to deliver complaint investigation findings. On 04/13/2023, LPA Kruz Long, conducted the initial visit, during visit, LPA Long took a photo of the Staff/Resident rosters, attempted to obtain a copy of R#2's records (Physician's Report, Appraisal Needs and Services Plan). LPA interviewed Staff #1, #2 #3 and interviewed Resident #1 (R#1). Resident #2 (R#2) was not present in the facility. Regarding allegation: Facility failed to provide a safe environment for a resident in care. It is alleged, that staff are not providing a safe environment for residents, as a resident was assaulted in the facility. Interviews with 6 out of 6 residents revealed, residents residing at the facility feel safe and secure, and residents have not witnessed any assaultive behavior from other residents or staff. During the investigation, Resident #1 (R1) and Resident #2 (R2) were not interviewed, as R1 & R2 are deceased. Interviews with 5 out of 5 staff revealed, the staff treats residents with respect and kindness. Staff reported the only incident witnessed by staff regarding assaultive behavior occurred on 03/28/23 between R1 and R2. Staff separated the residents and reported no visible injuries were noted. Therefore the investigation revealed, on 03/28/2023, R1 was assaulted by R2, and R1 did not sustain any injury. Staff who were present during the incident, separated R1 and R2, and staff performed assessed R1 for injury. Therefore, the investigation did not reveal any evidence to support that staff are not providing a safe environment for residents in care. Based upon records review and interviews conducted, the findings indicate that, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. Exit interview conducted with Staff in Charge - Caregiver Joanne Hernandez. A copy of the licensing report was provided at time of visit.the state’s words, verbatim · CDSS document, May 14, 2024 · control 28-AS-20230406145142

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Sanjay Vaid and Licensing Program Manager (LPM) Fernando Fierros conducted a case management visit regarding deficiencies noted during visits conducted on 04/09/24 and 05/02/24. LPA Vaid met with lead staff, Joanne Hernandez, and spoke with Licensee Toby Miclat via telephone and discussed the purpose of the visit. During 04/09/2024 visit, LPA Vaid interviewed Administrator and reviewed Resident #2 (R2) facility file. LPA obtained a copy of R2’s admission agreement, and any incident reports regarding R2. Administrator reported R2 went on an outing with family for the period 04/13/23 through 04/16/2023 and R2 was expected to return to the facility on 04/16/2023. However, R2 did not return to the facility after the outing with family. On 04/15/2023, R2 was sent to the hospital for observation, while R2 was hospitalized, R2 passed away on 04/16/23 due to a medical issues. However, the facility failed to provide licensing with an incident report regarding R2s hospitalization and death. Per Administrator, R2 was never discharged from the facility. R2 was a resident of the facility when hospitalized on 04/15/2023 and on R2’s date of death. Deficiencies cited per Title 22 Chapter 6 Division 8, Refer to attached LIC 809D. Exit interview was conducted with caregiver, Joanne Hernandez. Licensing report and appeals rights were given.the state’s words, verbatim · CDSS document, May 14, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(A) · Plan of correction due date: May 17, 2024

Reporting Requirements a) Each licensee shall furnish to the licensing agency such reports...(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence...(A)Death of any resident from any cause regardless of where the death occurred, including but not limite... to visiting away from the facility. The requirement was not met as evidence by R2 was hospitalized on 04/15/23 and passed away on 04/16/23, however, facility failed to report R2 hospitalization and death to licensing per Title 22 regulations.the state’s words, verbatim · CDSS document, May 14, 2024

Plan of correction: Administrator to send an incident report (LIC624A) for R2 by POC Due date 05/17/2024. On 04/09/24, Administrator provided a copy of R2’s death certificate to LPA Vaid.

Allegation investigated: Facility failed to provide a safe environment for a resident in care.

At 8:49 am Licensing Program Analyst (LPA) Sanjay Vaid was met by staff- Joanne Hernandez and Mark Reyes, explained the purpose of the visit, the administrator was notified. LPA and staff Hernandez toured the facility and conducted brief interviews with residents. Administrator- Lea Loaiza and Licensee -Toby Miclat arrived 30 minutes later and the purpose of the visit was discussed. ***This report supersedes the previous complaint report dated 04/09/24. The reason it’s being superseded is to provide additional information not included on the original LIC9099 dated 04/09/24, and to remove the LIC 9099D deficiency cited. The Unsubstantiated Finding will remain the same** Licensing Program Analyst (LPA) Sanjay Vaid and Tyler Reyes conducted a subsequent complaint visit on 04/09/24 regarding the allegation listed above to deliver complaint investigation findings. LPA Vaid and Reyes met with licensee-Toby Miclat and administrator- Lea Loaiza and discussed the purpose of the visit, which was to deliver complaint investigation findings. . Unsubstantiated On 04/13/2023, LPA Kruz Long, conducted the initial visit, during visit, LPA Long took a photo of the Staff/Resident rosters, attempted to obtain a copy of R#2's records (Physician's Report, Appraisal Needs and Services Plan). LPA interviewed Staff #1, #2 #3 and interviewed Resident #1 (R#1). Resident #2 (R#2) was not present in the facility. On todays visit, LPA Vaid interviewed residents, owner, administrator, and staff, and toured the physical plant and observed the facility to be clean, in good condition and free of obstacles throughout. Regarding allegation: Facility failed to provide a safe environment for a resident in care. It is alleged, that staff are not providing a safe environment for residents, as a resident was assaulted in the facility. Interviews with 6 out of 6 residents revealed, residents are feeling safe and secure residing at the facility, and residents have not witnessed any assaultive behavior from other residents or staff. During the investigation, Resident #1 (R1) and Resident #2 (R2) were not interviewed, as R1 & R2 are deceased. Interviews with 5 out of 5 staff revealed, the staff treats residents in care with respect and kindness. Except for the incident in year 2023, no other assaultive behavior has been witnessed by the staff. The investigation revealed, on 03/28/2023, R1 was assaulted by R2, and R1 did not sustain any injury. Staff who were present during the incident, separated R1 and R2, and staff performed assessed R1 for injury. Therefore, the investigation did not reveal any evidence to support that staff are not providing a safe environment for residents in care. Based upon records review and interviews conducted, the findings indicate that, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. Exit interview conducted with Lea Loaiza, Administrator. A copy of the licensing report was provided at time of visit.the state’s words, verbatim · CDSS document, May 2, 2024 · control 28-AS-20230406145142

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(A) · Plan of correction due date: May 2, 2024

87211 (a)(1)(A) a) Each licensee shall furnish to the licensing agency such reports...(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence...(A)Death of any resident from any cause regardless of where the death occurred, including but not limite... to visiting away from the facility. This requirement wasn't met as evidenced by: R2 was hospitalized on ?? and passed away on 04/16/23, however, facility failed to report R2 hospitalization and death to licensing per Title 22 regulations.the state’s words, verbatim · CDSS document, May 2, 2024

Plan of correction: Plan of Correction: On 04/09/24, Administrator provided a copy of R2’s death certificate to LPA Vaid. Administrator to send an incident report (LIC624A) for R1 and R2 by POC Due date 05/06/2024.

Allegation investigated: Facility failed to provide a safe environment for a resident in care.

Licensing Program Analyst (LPA) Sanjay Vaid and Tyler Reyes conducted a subsequent complaint visit regarding the allegation listed above to deliver complaint investigation findings. LPA Vaid and Reyes met with Toby Miclat-owner and Lea Loaiza- administrator and discussed the purpose of the visit, which was to deliver complaint investigation findings. On 04/13/2023, LPA Kruz Long, conducted the initial visit, during visit, LPA Long took a photo of the Staff/Resident rosters, attempted to obtain a copy of R#2's records (Physician's Report, Appraisal Needs and Services Plan). LPA interviewed Staff #1, #2 #3 and interviewed Resident #1 (R#1). Resident #2 (R#2) was not present in the facility. On todays visit, LPA Vaid interviewed residents, owner, administrator, and staff, and toured the physical plant with Lea Loaiza -Administrator and observed the facility to be clean, in good condition and free of obstacles throughout. Regarding allegation: Facility failed to provide a safe environment for a resident in care. It is alleged, that staff are not providing a safe environment for residents, as a resident was assaulted in the facility. Unsubstantiated Interviews with 6 out of 6 residents revealed, they are feeling safe and secure living at the facility and have not witnessed any assaultive behavior from other residents. Interviews with 5 out of 5 staff revealed, the staff treats residents in care with respect and kindness. Except for the incident in year 2023, no other assaultive behavior has been witnessed by the staff. On 03/28/2023 a resident #1 (R1) was assaulted by resident #2 (R2) and did not sustain any injury. Staff were present and separated R1 and R2. There is no evidence to support that staff are not providing a safe environment for residents in care. Based upon records review and interviews conducted, the findings indicate that, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. Two deficiencies were noted today, failure by facility to provide death report within 7 days of the occurrence for each resident. Exit interview conducted with Lea Loaiza, Administrator. A copy of the licensing report was provided at time of visit.the state’s words, verbatim · CDSS document, Apr 9, 2024 · control 28-AS-20230406145142

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(A) · Plan of correction due date: Apr 9, 2024

(a) Each licensee shall furnish to the licensing agency such reports...(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence...(A)Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility.the state’s words, verbatim · CDSS document, Apr 9, 2024

Plan of correction: Faciility will submit copy of death certificates for R2 and death report for R1 and R2 by 4/16/2024.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Wong conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to caregiver Adora Capa and the facility administrator Lea Chavez arrived shortly after. The facility is licensed for 6 residents with age range 60 and over. 6 Non-ambulatory and hospice waiver for 4. Currently, the facility has four hospice waiver residents, no home health, one on oxygen and no bedridden residents. The following 12 (CARE) tool domains were utilized during the inspection: Infection Control, Operational Requirements, Physical Plant/Environment Safety, Staffing, Personnel Records/Staff Training, Resident Records/Incident Reports, Planned Activities, Food Service, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: Infection Control Practices and Personal Protective Equipment (PPE) supplies were observed. Facility Staff still practice hand washing and wear mask in the facility. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. Operational Requirement: The facility has a Dementia Waiver in place. A Hospice Waiver for 4 residents is approved. All resident in the facility is non-ambulatory which is under the fire clearance approval. The facility does not have the actual liability insurance policy and they only have the quote for the liability insurance. Physical Plant and Environmental Safety: The facility is a single story house and located in a residential neighborhood area. The facility includes: kitchen, living room, dining area, 6 residents bedroom, 4 bathrooms, laundry room, pantry room and an attached garage. LPA inspected the resident room and each resident room has one bed, one chair, night stand, required furniture and beddings and sufficient lighting and closet space. LPA inspected the bathrooms, each bathroom is clean, sanitary and in a good working condition. Each bathroom has the required grab bar and non-skid mat. The hot water in all resident bathroom are tested between 110.8 and 114 degrees F. which is within the Title 22 regulation. The appliances in the kitchen and living room are working well. The sharp knives are stored and locked in the kitchen cabinet. All the cleaning supplies and chemicals are stored and locked in the garage. The extra linen and towels are stored in the cabinet near the residents room. LPA inspected the carbon monoxide detectors and smoke detectors and they are located in each bedroom and common area and they are all working well. The facility has a pool with water in the backyard. The pool water was clean and pool is surrounded by a locked gated. The passageway, walkway and patio are free of obstruction. Staffing: The facility has sufficient staffing in the facility. The facility has at least one person to have updated First Aid and CPR training certificate. Personnel Records-Training Information: All the staff work in the facility are over 18 yeas old and background checked and associated with the facility. All the staff file has the required documents include: health screening, TB test result, updated First Aid Certificate and required training hours. The administrator is Toby Miclat and her administrator certificate was expired on 10/12/2023 and currently the certificate is pending with CCL system since 11/28/23. Resident's right/Information: The complaint poster from LTCO and CCL are placed on the wall near the entrance door which included the resident personal right and theft and loss policy. The facility also has internet service which provide at least one internet access device such as computer or smart phone..etc for video conferencing with resident's family. Planned Activities: The facility has a sufficient space to accommodate both indoor and outdoor activities. Food Service: The facility has sufficient food supply for two days perishable and seven days non-perishable food in the facility. Currently there's no resident is on a modified diet that prescribed by the doctor. All the food in the facility are stored properly. Incidental Medical and Dental: LPA reviewed six residents' medication. R1's daily medication for Vitamin D3 and Omerprazole was not listed on the MARs and not sure if resident was taking the medication. The medication in the facility is centrally stored and locked in the kitchen cabinet. LPA also inspected the First Aid Kit in the facility and they have all the required supplies and updated Manual and stored and locked in the kitchen cabinet. Resident's Record-Incident Reports: A total of six (6) resident files were reviewed. They contained admission agreements, Physician's Reports, Appraisal, TB clearance, medical consent, and medication records. ***A total of 1 Dementia resident (R1) had Physician Report's older than 12 months. All the residents admission agreement is print double side of the paper. Disaster Preparedness: The updated Emergency and Disaster Plan LIC 610E is in place and posted on the wall. The facility did not conduct any emergency disaster drill last year. Resident's appraisal and Needs services plans are part of Emergency training. Residents with Special Health Needs: Four (4) residents receive hospice care. Half and Full bed rails for mobility assistance were observed in residents' rooms. LPA observed one resident (R2) has no doctor order for the half bed rail. Individual Service Plans and appraisals are on file. No Residents have prohibited health condition. Per California Code of Regulations, Title 22, deficiencies were cited. Exit interview was conducted with Lea Chavez. A copy of the report and appeal rights were issued.the state’s words, verbatim · CDSS document, Jan 12, 2024