Routine inspection·June 21, 2024

On this day, June 21, 2024, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA was granted entry by staff, Aaron Salvador. LPA called and spoke over the phone with Sharon Aranha, administrator, and informed the reason for visit. LPA also met with other staff, Mark Kevin Salvador. Administrator arrived at 12:29 p.m. Facility has submitted the LIC808 Mitigation Plan but not the LIC9282 Infection Control Plan. LPA requested for LIC9282 on June 23, 2023 which LPA has not received up to this day. LPA inspected the facility inside and out with Mark Kevin Salvador, LPA inspected the kitchen, dining room, living and family rooms, bedrooms, bathrooms, garage, front, side and backyard. Facility has sufficient perishable and non-perishable foods. Facility has smoke and carbon monoxide detectors that were checked and observed in operating condition. Hot water temperature in the ensuite bathroom was tested. Facility conducts drills every quarter and records showed fire drill last conducted 5/01/24. LPA reviewed 5 residents and 4 staff files, and interviewed 2 staff and 2 residents. Medications were checked and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Records. Facility does not handle residents' cash resources. LPA observed the following: -at 11:57 a.m., hot water was at 124 degrees Fahrenheit. -at 11:58 a.m., Ca-Rezz incontinent wash in one of the residents' rooms. -at 12:03 p.m., razor in the cabinet in the common bathroom. -at 12:06 p.m., Ca-Rezz continent wash and ointment in another resident's room. .....continued on 809C (page 2) Page 2 -at 12:45 pm.m, trash cans in 2 residents rooms without lids. -at 2:00 pm to 2:35 p.m., staff (S2, S3, S4) who were hired 10/18/23 have only total 21 hours of training on file and no medication training. -at 3:30 p.m. to 4:00 p.m, , residents (R1, R2, R3, R4 and R5) have no Pre-admission Appraisal on file. R4's LIC602A Physician's Report indicated R4 needs assistance with all activities of daily living (ADLs); however, LPA observed R4 feeding self during lunch. R5's LIC602A Physician's Report indicated R5 needs assistance on with all ADLs. LPA received a copy of $3M Liability Insurance certificate on this day. Administrator to submit copies of the following updated documents by July 5, 2024: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. LIC9282 Infection Control Plan 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 penalties. 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.