Routine inspection·September 19, 2024

On this day, September 19, 2024, at10:30 AM, Licensing Program Analysts (LPAs) David Doidge and Alicia Delmundo arrived unannounced to conduct an annual required inspection. LPAs met with Sarah Chu, Assistant to the Administrator. and informed the reason for visit. Administrator Helen Blain arrived at 11:00 AM. Facility has Infection Control Plan that was submitted on which a copy was received on this day, 09/19/2024. LPAs toured the facility inside out with Helen Blain and Sarah Chu. LPAs 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 and cleaning supplies were 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 105 degrees Fahrenheit. Facility conduct fire drill every quarter last 06/15/2024. Administrator stated will conduct next drill this month. Fire extinguishers were observed fully charge and showed serviced 05/26/2024. LPAs reviewed 5 staff and 5 residents files. Medications inspected and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Record. Facility does not handle resident cash resources.. LPAs observed the following: -at 10:35 AM, front door had two extra locks, one latch one that locks vertically. Continued on 809C Continued from 809 -at 11:15 AM, fire perimeter fence gate with lock -at 11:32 AM, ointment found unlocked in common bathroom -at 11:40 AM, anti fungal spray and razor found unlocked in resident’s room. -at 11:56 AM, Efferdent dental cleaner found unlocked in resident’s room. -at 12:14 PM, Lysol spray found unlocked in resident shared toilet. -at 3:34 PM, quantity of two medication not listed on LIC622. Date filled scratched out by med tech for R4. -at 4:00 PM, R1, R2 and R3 have half bed rails but no doctor's orders on file. Administrator provided the following updated/current documents on this day: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. $3M Liability Insurance certificate Administrator to submit Updated Articles of Organization by October 3, 2024. Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. $500.00 civil penalty is assessed for fire safety violation for having the perimeter fence locked and front door locked with latch locks. 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. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided