Routine inspection·December 8, 2023

On this day, December 8, 2023, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with Olive 'Lyn' Lopez-Neri, administrator, and informed the reason for visit. LPA also met with other staff, John Louie Neri and Liwayway Manansala. Administrator submitted the facility's Infection Control Plan which LPA received on February 20, 2023. LPA toured the facility inside out with the administrator. LPA inspected the kitchen, dining area, living room, bedrooms, common and ensuite bathrooms, side yard and backyard. 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. Facility conducts disaster drills every month, and records showed last conducted December 5, 2023. Fire extinguisher checked, observed fully charge with tag showed serviced July 26, 2023. Hot water temperature in the ensuite bathroom was tested and measured at 109.6 degrees Fahrenheit. LPA reviewed 4 staff and 5 residents files, and interviewed 2 staff and 2 residents. Medications inspected and compared with records and doctor's orders. Residents P&I checked and compared with records. LPA received the following updated/current documents: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) . .....continued on 809C Administrator to submit updated/current copies of the following documents by December 22, 2023: 1. $3M liability insurance certificate 2. Proof of Surety Bond coverage The following deficiencies were observed and 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. -at 1:45 pm, S1 does not have record of postural support training on file. -at 1:55 pm, S2 does not have record of postural support and restricted health condition training on file. -at 2:05pm, S3 does not have record of hospice care, postural support and restricted health condition training on file. -from 2:45 pm to 3:25 pm, R1, R3, R4 and R5's LIC602As are over a year old. -from 3:25 pm to 3:40 pm, LIC625 Appraisal/Needs and Services Plan for R1, R4 and R5 are over a year old. -from 3:41 to 3:55 pm, all 5 residents have no Pre-admission Appraisal on file. -at 4:30 pm, R1 has doctor's order for the following but the facility does have them: Acetaminophen; Cholecalciferol; Ferrous Sulfate; Folic Acid; Sennosides. Facility has the following medications on hand but no doctor's order on file: Baclofen; Dutasteride. Paroxetine on hand does not match the dosage on doctor's order on file. 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.