M & L South Bay Maxi Care

Type of visit: Required - 1 Year

At 9:00am on 10/02/2025. Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to conduct the annual facility inspection. LPA met with Licensee/Administrator, Lita Lazo announced who he is and the reason for the visit. During the time of the inspection there were zero Residents residing at this facility. Administrator and LPA conducted a cursory physical tour of the facility. LPA noted that this is an 8 bedroom, 10 bathroom, 3 living rooms (one living rooms is a dinning/living rooms), one main kitchen and one kitchenette. The outside is an expansive area around the facility and there are chars and covered patio for activities and visitors near the front entrance. Six bedrooms are single client occupancy, and the other two bedrooms are designated as staff bedrooms. All 8 bedrooms have on suite bathrooms and there are an additional two bathrooms located in common areas of the facility. All bathrooms had paper towels and liquid soap. Water temperature was tested throughout the facility to be within regulation parameters (105*-120*(f)). LPA observed proper linens and furniture in all resident bedrooms. LPA reviewed infection control plan. emergency disaster plan, and staff files. LPA reviewed all of the care tool modules with Licensee. During the physical inspection the following deficiencies were cited: (87555(b)(23)) Food storage, peanuts and fruits were left out and not properly stored which resulted in mold and knats accumulation over the peanuts and fruits; (87203) Fire Safety, two of eleven smoke detectors were not functioning at time of annual inspection; and (87307(d)(6)) Hallway leading to exit was obstructed by boxes of planed storage. At this time there are no other violations or citations issued as a result of the facility annual inspection. Exit interview, report read, report and appeal rights provided.the state’s words, verbatim · CDSS document, Oct 2, 2025

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rankin conducted a 1-year annual visit to the facility above. LPA met with Licensee/Administrator Lita Lazo and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Physical Plant & Environmental Safety: The facility has 8 bedrooms and 10 bathrooms, at time of visit there were no residents living at the facility. The facility currently has 2 live-in staff. The facility is clean, safe, and sanitary. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors which were tested and were working at time of visit. The showers have non-skid mats. 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. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care and locked in cupboards. The facility has sufficient space inside and outside for activities and visiting. The facility has a pathway around the house and a sitting area in front yard for client use with shade. The facility has telephone and internet service for resident use. Operational Requirements: The facility has a current plan of operation and infection control plan 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 08/01/2025. The facility is approved for a capacity of 6 Non- Ambulatory, and Hospice approved for 3 residents. Continued on 809-C Food Service: 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. Emergency supply of food and water is available. Kitchen areas are kept clean and free insects and rodents. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts quarterly disaster drills. The fire extinguishers were charged and last inspected 11/4/2024. 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. The facility has a back-up solar batter for emergencies. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger such as, sharps, and cleaners were locked or inaccessible to residents in care. The facility has exiting door alarms for the safety of residents in care. Personnel Records & Training: The facility currently employes 2 staff and 2 Administrators. Staff records are kept confidential. LPA reviewed 2 staff files for 1st AID/CPR, Fingerprint clearances, Applications, Health exam with TB results, and Criminal Record statement. Annual training was complete with the exception of a a couple hours that are scheduled to occur in the next 30 days. Residents Rights - All require postings were posted in the common area of the facility. The current license is posted. Resident Records & Incident Reports: The facility keeps confidential files on each resident. Two files of past residents were reviewed for signed Admission Agreements, Medical Assessments LIC. 602A Physicians Report, ID and Emergency contact forms, Appraisal Needs and Services plans (ANS), TB results, Personal Rights. Facility does submit incident reports to the department when required. Medication cabinet was reviewed, there are no residents at the facility so the cabinet was empty. Exit interview completed and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Nov 18, 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.

Allegation investigated: Staff handled resident in a rough manner Staff hit resident Staff are not able to effectively communicate with residents Residents cannot have visitors without an appointment

Licensing Program Analyst (LPA) Rachael De Leon (De Leon) conducted an unannounced initial complaint visit to the facility above on 10/6/23. De Leon toured the inside and outside of the facility with Administrator. On September 27, 2024, LPA Miller met with Lita C. Lazo, Administrator, and issued final findings on the allegations above. LPA interviewed staff, reviewed relevant documentation and took a cursory tour of facility. Allegation: Staff handled resident in a rough manner and hit residents Reporting party (RP) alleges that there are only two residents who are verbal and complain about the treatment they receive at this facility. RP alleges that R1 stated that they have been hit in the face and dragged across the floor. RP stated that Resident 2 (R2), stated that she is frightened of staff. Continued on 9099C Unsubstantiated Administrator advised that R1 passed away on 3/29/24 and provided copy of LIC 624 that was sent to CCL. Administrator advised that R2 vacated the facility in August of 2024 to move out of the local area. Administrator refutes the allegation in its entirety as they have never observed staff hit or handle residents in a rough manner. Administrator further stated that R1 wanted to leave the facility and live at her own residence, as evidenced in the hospice report dated 10/25/22. Staff 1 (S1) has been working at facility since June of 2017 and never observed staff handle residents in a rough manner or hit residents. S1 claims they would have reported any abuse to administrator. S1 recalls two residents living at facility at the time of the allegation. Staff 1 recalls that R1 was aggressive and attempted to hit S1 in the face. S1 stated that they did not lay hands on R1, but blocked R1's hand. S1 recalls R1 making false statements about paying for other resident’s expenses. R1 was best friends with R2 , but they also argued. LPA reviewed R1’s medical assessment that reflects R1 had mild cognitive impairment. 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 is Unsubstantiated. Allegation: Staff are not able to effectively communicate with residents RP alleges that there is a language barrier between staff and residents. LPA observed that Administrator and S1 were able to communicate effectively in English. Administrator and S1 stated they did not have trouble communicating with residents and that both residents were verbal and the time of the allegations. S1 stated that there was a staff member that left in January 2024, who had an Australian accent, but did not have an issue communicating with residents. 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 is Unsubstantiated. Continued on 9099-C Allegation: Residents cannot have visitors without an appointment RP stated they visited a resident every Wednesday and made appointments to visit R1 the exact time every week, since before the pandemic. Administrator and S1 stated that residents have never been required to schedule an appointment to have visitors. They have no knowledge of the arrangements the visitors made with R1. S1 further stated that in the past visitors often dropped by unannounced. The only resident on-site is currently sleeping and is unavailable to answer questions. There is no evidence to support that visitors are required to make appointments. 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 is Unsubstantiated. An Exit interview conducted, and a copy of this report issued.the state’s words, verbatim · CDSS document, Sep 27, 2024 · control 29-AS-20231004123019

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) De Leon conducted a 1 year annual visit to the facility above. LPA met with Licensee/Administrator Lita Lazo and explained the purpose of the visit. LPA requested the following records from the Administrator: LIC, 500 Staff Roster, Register of Residents, Emergency & Disaster Plan, Documentation of Quarterly Emergency Drills, Copy of Liability Insurance, Copy of Admission Agreement with Addendums, Copy of Annual Fire Inspection/Certification of Fire System. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Infection Control: The facility has a current infection Control Plan on file. The facility has a sign in and out note pad with hand sanitizer. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. The facility has EPA approved disinfectants 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). All trash cans and waste baskets need to tight fitting lids. Physical Plant & Environmental Safety: The facility is a 8 bedroom and 10 bathroom currently occupying 5 residents and employs 4 staff. The facility currently has 2 live-in staff. The facility is clean, safe and sanitary. 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 residents comfort. The facility kitchen is clean, safe and sanitary. The showers have non-skid mats. 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. Continued 809-C Disinfectant, cleaning solutions and poisons are inaccessible to residents in care and locked in garage and locked in cupboards. The facility has sufficient space inside and outside for activities and visiting. The facility has a pathway around the house and a sitting area in front yard for client use with shade. The facility has telephone and internet service for resident use. The facility provides resident with a shared computer with confidential internet access. Operational Requirements: The facility has a current plan of operation and infection control plan 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 08/01/2024. The facility is approved for a capacity of 6 Non- Ambulatory, and Hospice approved for 3 residents. 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. Emergency supply of food and water is available. Cleaning solutions and equipment are stored separately from food supplies. Kitchen areas are kept clean and free from litter, rodents, vermin and insects. Kitchen staff are observed for personal hygiene and food sanitation practices. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts quarterly disaster drills. The fire extinguishers were charged and last inspected 10/22/2022. 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. The facility has a generator for emergencies and for back up power outages. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked or in accessible to residents in care. The facility does not currently have any residents on oxygen. The facility does not currently have any hospice residents in care. Hospice care plans are kept on file and up to date for any residents on hospice services.. The facility currently has 1 resident on Home Health services. Home Health services records are kept on file. The facility has exiting door alarms for the safety of residents in care. Continued 809-C Staffing: The facility employes 4 staff and 1 Administrators Staff records are kept confidential. LPA will return at a later date to review staff records. Personnel Records & Training: The facility keeps confidential files for each staff member. LPA will return at a later date to review staff training records. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. LPA will return at a later date to review resident records. Incidental Medical & Dental: The facility has a locked medication cupboard in the dining room area. Facility provides transportation or assists in providing transportation to medical and dental appointments when needed. LPA will return at a later date to review medications and medication records. LPA will conduct interview with staff and residents upon return to complete the annual visit. Exit interview conducted, deficiency cited, copy of report and appeal rights printed for Administrator.the state’s words, verbatim · CDSS document, Oct 6, 2023

The state marks this report as 9 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.