Routine inspection·August 28, 2024

On 8/28/2024 at 9:30 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with On-Call Nurse, Merdith Castro and explained the purpose of the visit. The facility’s fire clearance was approved for 6 Non-Ambulatory of which 1 may be bedridden in room 2 only. Facility currently has 2 bedridden residents at the facility that are not in hospice. LPA toured facility with Caregiver, Rommel Dimzon including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which all bedrooms are occupied by the residents. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 76 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 112.5 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last purchased on 4/08/2024. Emergency Disaster Plan was not posted or available for review. First aid kit was observed to be complete. Emergency disaster drill was last conducted in February but facility does not have any record. At 1:00pm, LPA reviewed 6 of 6 residents records. At 2:20pm, LPA reviewed 3 staff records and 3 of 3 have current first aid training and associated to the facility. THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 10:37AM LPA observed that medicine cabinet was unlocked and unsupervised. staff locked cabinet. At 10:77AM LPA observed that sharps drawer with knives and scissors was unlocked and unsupervised. staff locked cabinet. At 10:38AM LPA observed a bottle of Oil Eater on the clients bathroom counter. Staff removed solution. At 10:56AM LPA observed an individual who is not currently fingerprint cleared and has previously been marked "NOT ELIGIBLE" working at the facility unsupervised. Individual left facility. (Civil Penalty $100) At 1:13PM LPA observed R1 to be designated as BEDRIDDEN and in room 5. (Civil Penalty $500) At 3:20PM The facility did not have an Emergency Disaster plan available for review At 3:25PM The facility did not have disaster drill logs available for review but said they did a drill in February. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 9/10/2024: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Current Administrator’s Certificate ****Total Civil Penalties Assessed $600**** 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.