Routine inspection·August 7, 2024

On this day, August 7, 2024, at 10:30 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Warlita Romero and Margarita Corazon Mariano. LPA called and spoke over the phone with Justino Balintona, licensee-administrator, and informed the reason for visit. LPA asked, and licensee authorized Warlita Romero to be with LPA during inspection. Licensee-administrator arrived after about 25 minutes. Facility has Infection Control Plan that was submitted on 8/19/22. LPA started inspection with Margarita Corazon Mariano and continued with administrator. LPA inspected the dining room, kitchen, bedrooms, bathrooms, living room, side and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was 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 108 degrees Fahrenheit. Facility conducts drills and record showed last conducted 7/08/24. LPA reviewed 4 staff and 5 residents files, and interviewed 2 staff. Facility does not handle residents' cash resources. Medications checked, and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Records. LPA observed the following: -at 10:42 am, refrigerator's vegetable crispers with mold, rotten bitter melon leaves, rotten asparagus and lettuce. ...continued on 809C (page 2) Page 2 -at 10:52 am, Voltaren, athlete's foot and hydrocortisone ointments in the drawer in one of the resident's room, and CaRezz continent and Chloehexine gluconate rinse in the closet in this resident's room. -at 11:07 am and 11:09 am, broken drawer knobs in 2 resident rooms and missing drawer knob in the drawer by the hallway. -at 11:10 am, razors in the common bathroom. -at 11:12 am, bathroom cabinets with heavily peeled varnish and soiled bath tub. -at 11:17 am, ensuite bathroom's shower door with mildew. -at 11:20 am, Raid insect killer, gallons of liquid sanitizer, expired canned foods and rotten cauliflower in unlocked storage in the backyard. - at 11:24 am, automotive agents, bug and windshield cleaner, stain remover, rusted metal cart in the backyard. -at 11:38 am, staff's medications in the living room. -at 1:49 pm, resident's (R2) LIC602A Physician's Report revealed R2 is bedridden and dependent on others with all activities of daily living (ADLs). LPA observed R2 unable to reposition on his own. -at 2:50 pm, resident (R1) has doctor's order for Mupirocin (3x/day), Asprin 81 mg (1 tab/day), Colchicine, but facility does not have these meds. Acetaminophen 315 mg (PRN) but at facility's hand is 500 mg. HydrAlazine order is 50 mg 3x/day but at facilty's hand is 25 mg 3x/day. Quetiapine 25 mg 1 tablet daily but label on this medication is 2x/day. Vitamin D3's order is 25 mcg (1,000 IU) but on hand is 50 mcg (2,000 IU) and facility administers 50 mcg daily. Voltaren, multi Vitamins & stool softener have no order on file. -at 3:35 pm, resident (R4) has order for 2.5 mg Lisinopril but facility does not have this medication. -at 4:00 pm, resident (R5) has discontinued order for Lisinopril 20 mg but facility is administering this medication. Has order for Albuterol 2.5 mg but facility does not have this medication. Has Quetiapine 25 mg but no doctor's order on file. ....continued on 809C (page 3) Page 3 LPA received 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 Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. A $500.00 civil penalty is assessed for deficiency section 87202(a)(2). 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 licensee-administrator. Exit interview conducted. Appeal Rights, LIC421IM Civil Penalty Assessment, LIC9098 Proof of Correction form and copy of this report provided.