Routine inspection·August 28, 2024

On this day, August 28, 2023, at 1:40 pm, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Ermi Macaraig, and informed the reason for visit. LPA called and spoke over the phone with Juliana Taburaza, administrator. LPA also met with other staff, Edwin Villarin. Administrator arrived after about 2 hours. Facility has Infection Control Plan that was submitted on June 30, 2022. LPA toured the facility inside out with Ermi Macaraig. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, front, 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 the common bathroom was tested, and measured at 112.8 degrees Fahrenheit. Facility conducts disaster drills every month, and records showed last conducted 8/01/24. LPA reviewed 3 staff and 5 residents files. Medications inspected and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Record. Resident's P&I checked and compared with last recorded balance. LPA observed the following: -at 1:50 pm, peelers in kitchen drawer without lock. -at 1:56 pm, missing baseboard in the kitchen area. -at 1:59 pm to 2:01 pm, Tylenol and razors in the resident's room. ........continued on 809C (page 2) Page 2 -at 2:01 pm, medications in unlocked staff room. -at 2:04 pm, hair trimmer in another resident's room. -at 2:30 pm, shovel in the side yard. -at 6:15 pm, resident R1's dosage of 1 of the medications was crossed out and changed to 25 mg not by the prescribing doctor. The label on this medication showed 25 mg, 1 tablet everyday; however, the medications inside the bottle were cut into halves. The LIC622 for this medication showed 50 mg and no entry for quantity received by the facility. Administrator to submit the following updated/current documents by September 11, 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 penalty. Deficiencies and plan and proof of corrections were discussed with the administrator. Administrator has to leave and have Ermi Macaraig sign and receive this report. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.