Routine inspection·September 8, 2023

On 9/8/2023 at 10:00AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a Required - 1 Year inspection. LPA met with caregiver, Anna Horvath. Manager, Rachell Paniagua arrived 15 minutes later. The facility’s fire clearance was approved for 6 non-ambulatory residents and 2 residents may be under hospice care. LPA toured the facility including but not limited to bedrooms, bathrooms, dining area, kitchen, and outdoor area. Smoke and carbon monoxide detectors were observed. Fire extinguisher was observed to be full and last serviced on 5/10/2023. One week of nonperishable and 2-day of perishable food supplies were available. Hot water temperature was measured at 113 degrees F in the hallway bathroom. LPA observed grab bars and non-skid mat in the bathrooms. There were adequate lights in each room. Resident rooms were observed to be cleaned and fully furnished. First Aid kit is complete. Last fire drill was conducted on 8/2/2023. LPA reviewed 3 resident and 2 staff files starting at 11:00AM. LPA interviewed 2 residents and 1 staff starting at 1:30PM. LPA reviewed a sample of resident's medications starting at 1:45PM. At 11:30AM, LPA observed R2 does not have medical assessment and TB test on file. At 11:45AM, LPA observed R1 does not have a current reappraisal/needs and service plan on file. At 12:00PM, LPA observed S2 does not have a copy of chest x-ray results on file. At 12:30PM, LPA observed facility does not have a land line at the facility and only have a facility cell phone. Staff informed LPA that the land line was disconnected. (Continue on LIC809C...) At 2:00PM, LPA observed resident's centrally stored medication form (LIC622) was not filled out correctly and some medications were not written in the form. At 2:15PM, LPA observed staff was giving R3 Melatonin 5 mg when doctor's order dated 4/19/2023 was for Melatonin 3 mg. Staff purchased Melatonin 3 mg during visit. Flax oil 1000mg was given to R3 when doctor's order dated 4/19/2023 was for Flaxseed oil 1030mg. LPA did not observe doctor's order for R3's stool softener 100mg and PRN medication was given to R3. The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights were provided.