Routine inspection·January 30, 2024

On this day, January 30, 2024, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Ruth Carreon, Perlita Peria and Nimfa Boado, and informed the reason for visit. LPA called and spoke over the phone with Consuelo 'Connie' Galicia, licensee-administrator, who authorized Ruth Carreon to be with LPA in touring the facility. Administrator and Rolando Galicia, licensee, arrived at 12:20 p.m. Facility has LIC9282 Infection Control Plan that was submitted on 12/30/22 along with Monkeypox Infection Control Plan. LPA toured the facility inside out with Ruth Carreon. LPA inspected the kitchen, dining area, staff quarter/office, bedrooms, bathrooms, front and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Facility has smoke and carbon monoxide detectors that were tested, and observed functional. Hot water temperature in one of the bathrooms was tested and measured at 116.2 degrees Fahrenheit. LPA reviewed 4 staff and 5 residents records, and interviewed 2 staff and 2 residents. Medications were checked and compared with doctor's orders and LIC622 Centrally Stored and Medication Records. Facility does not handle residents' cash resources. LPA observed the following: -at 11:34 to 11:37 a.m., residents and staff medications unlocked in the staff quarter/office. -at 10:40 a.m., residents' medications in the kitchen counter and refrigerator. .....continued on 809C (page 2) Page 2 -at 11:41 a.m., expired salad dressing in the refrigerator (expiration: 9/27/22). -at 11:49 a.m., medications in one of residents rooms. -at 11:55 a.m., ointments and saline solution in another residents' room. -at 11:57 a.m., denture cleaners in residents' ensuite bathroom. -at 12:02 p.m., Comet, Lysol and Mr. Clean cleaning agents and fabric disinfectant in the common bathroom cabinet. - trash cans in the staff quarter and bathrooms with no lids. -at 12:27 p.m., fire extinguisher fully charge; however tag showed last serviced 4/08/22. -at 2:00 p.m., LPA asked and per administrator they have not conducted disaster drill since COVID-19 pandemic. -at 2;15 p.m., staff (S3 and S4) have no LIC503 Health Screening and TB test on file. -at 2:57 to 3:15 p.m., residents (R2 and R3) LIC602A Physician's Report and LIC625 Appraisal/Needs and Services Plan are over a year old. -at 3:30 p.m., resident (R4) does not have Pre-admission Appraisal on file. -at 3:45 p.m., residents (R2 and R3) half bed rails do not have doctor's orders on file. -at 4:00 p.mident (R1) has doctor's order for Silodosine but facility does not have this medication. Per staff (S2), this medication has run out for 3 days. Dosage of Cranberry Extract in facility hand does not match the doctor's order on file. -at 4:15 p.m., resident's (R2) has total of 6 medications and Vitamin supplements but no doctor's order on file. The following updated/current documents were received on this day: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) ....continued on 809C (page 3) Page 3 Administrator to submit a copy of $3M Liability Insurance certificate by February 13, 2024. Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. Failure to submit proof of corrections by plan of correction due dates, and any repeat violation within 12 month period may result in civil penalties. Deficiencies and plan and proof of corrections were discussed with the administrator. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.