Routine inspection·August 10, 2023

On this day, August 10, 2023, at 11:40 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Letecia Iroy, and informed the reason for visit. LPA called and spoke over the phone with Juliana Taburaza, administrator. LPA asked, and administrator stated she can not come to the facility, and authorized Letecia Iroy to be with LPA during inspection and sign and receive this report. Facility has Infection Control Plan that was submitted on June 30, 2022. LPA toured the facility inside out. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, side and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was observed locked. 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 113.8 degrees Fahrenheit. Facility conducts disaster drills quarterly, and records showed last conducted 7/02/23. LPA reviewed 4 staff and 5 residents files, and interviewed 1 staff and 2 residents. Medications checked, and compared with records and doctor's orders. LPA verified, and according to the administrator, facility handles only 2 residents' P&I. ...continued on 809C LPA observed the following: -at 12:18 pm, wood plank of the deck in the backyard with hole and some planks have signs of wearing out. -at 12:40 pm, LPA verified and S2 stated she administers medications; however, records showed no 8 hours required annual training for year 2022. S2 only has 4 hours dementia & no postural support/restricted health/hospice care training on file for year 2022. S3 who administers medications does not have 8 hours required annual training for year 2022 -at 1:30 and 1:45 pm, S3 and S4 has only 4 hours dementia & no postural support/restricted health/hospice care training on file for year 2022. -at 2:40 pm, residents' (R1, R2 & R3) LIC625 Appraisal/Needs and Services Plan on file are over a year old -at 4:00 pm, R3 has 2 medications but no doctor's order on file. Doctor's order on file for other 1 medication was 25 mg ( 1 tab at bedtime) bu t the medication on facility's hand is 50 mg (1 tab at bedtime). -P&1 cash and records of 2 residents (R3 and R4) are not in the facility. Administrator to submit the following updated/current documents by August 24, 2023: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. $3M Liability Insurance certificate 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 over the phone in the presence of Letecia Iroy. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.