Routine inspection·March 26, 2024

On 03/26/2024 at 9:30 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Ana Breen and explained the purpose of the visit. The facility’s fire clearance was approved for 6 non-ambulatory. LPA toured facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 4 bedrooms are available for residents and 2 bedrooms is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. The pool is locked and secured. A comfortable temperature is maintained at 78 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 111.8 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is not a minimum of one week supply of nonperishable and 2-day of perishable foods once expired and spoiled food was discarded. Centrally stored medication and sharps were not locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 12/29/2023. Emergency Disaster Plan was last reviewed on 10/05/2023. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 02/16/2024. At 11:00AM, LPA reviewed 1 of 1 residents records. At 11:30AM , LPA reviewed 3 of 3 staff records and 3 of 3 have current first aid training and arenassociated to the facility. Report continues on LIC 809-C THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 10:00 AM during facility tour LPA observed that food in refrigerator is spoiled and expired. There was spoiled bok choy, tomatoes, bagged salads, uncooked sausages, uncooked corned beef, asparagus, bell peppers, uncooked tri-tip, and uncooked hot dogs among other foods. LPA advised administrator to dispose of the spoiled food as well as the food that was cross contaminated. (repeat violation) 87555(b)(8) At 10:05 AM during facility tour LPA observed unlocked knife and a pair of scissors in the top oven. Also the sharps cabinet was unlocked and contained a butcher knife. (repeat violation) 87309(a) At 10:05 AM during facility tour LPA observed the oven to be missing the knobs for function. At 10:07 AM during facility tour LPA observed animal fecal matter smeared on floor At 10:14 AM during facility tour LPA observed a disorganized closet with unlocked Combat Roach killing gel. (repeat violation) 87309(a) At 10:16 AM during facility tour LPA observed a bottle of Lisinopril 10MG on table in common area. (repeat violation) 87465(h)(2) At 10:18 AM during facility tour LPA observed a broken latch on sliding door in R1's room. Door was also cushioned with pad used for incontinence. (repeat violation) 87303(a) At 10:18 AM during facility tour LPA observed layers of cobwebs in R1's bedroom at the top of sliding door. At 10:20 AM during facility tour LPA observed infestation of ants in laundry room as well as a mildew odor Report continues on LIC 809-C THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT CONTINUED: At 10:25 AM during facility tour LPA observed a screen door with holes and in disrepair 10:00AM -10:29AM Facility was observed unsanitary throughout. Dirt on walls, floors, grease on kitchen appliances, odor throughout facility, surfaces sticky. (repeat violation) 87303(a) At 11:30 AM during file review LPA observed that R1's physicians report states that they are bedridden and facility is not cleared for bedridden ( Immediate $500 civil penalty) ***An Immediate $500 civil penalty is being assessed for fire clearance violation*** *** A $250 civil penalty is being assessed for each repeat violation ($250 X 4)**** The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.