Routine inspection (multi-day)·May 17, 2024

On this day, May 17, 2024, Licensing Program Analyst (LPA) Delmundo conducted unannounced visit to continue the annual inspection that was started on May 1, 2024. LPA met with Roselyn Chand, acting administrator, and informed the reason for visit. LPA reviewed 5 staff and 5 residents files and interviewed 1 staff. Medications were checked and compared with doctor's order of medications and LIC622 Centrally Stored Medication and Destruction Records. Facility does not handle residents' cash resources. LPA observed the following: -at 12:10 pm, staff (S1) has n o 4 hours required training on file on postural support/restricted health conditions/hospice care. -at 12:30 pm, S3 is CPR/AED certified but no First Aid certificate on file. -at 1:40 pm, S4 is CPR/AED certified but no First Aid certificate on file. -at 1:25 pm, resident's (R2) LIC602A indicated non-ambulatory, and R2 needs cane to move around and about but the facility is not licensed and not fire cleared for non-ambulatory -at 3:00 pm, resident (R5)'s doctor's order 1/16/24 for 1 of medications is 50 mg, 2x daily but the label on the medication filled on 4/18/24 showed 1 tablet daily. ....continued on 809C (page 2) Page 2 Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds. A $500.00 civil penalty is assessed for deficiency section 87202(a)(1). Failure to submit proof of corrections by plan of correction due dates may result in additional civil penalty. Deficiencies and plan, and proof of corrections were discussed with the acting administrator. Exit interview conducted. Appeal Rights, LIC421IM Civil Penalty Assessment, LIC9098 Proof of Correction form, and copy of this report provided.