Routine inspection·March 14, 2023

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to Administrator Carmen Galicia. There are currently 58 elderly residents 60 years and older residing in the facility. One resident (1) is receiving hospice care. The following 12 (CARE) tool domains were utilized during the inspection: Infection Control, Operational Requirements, Physical Plant/Environment Safety, Staffing, Personnel Records/Staff Training, Resident Records/Incident Reports, Planned Activities, Food Service, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. There is a visitor sign-in station located in the main entrance lobby. Room # 232 is designated as a COVID-19 isolation room if needed. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. Operational Requirements: A current Plan of Operation was reviewed. The Infection Control Plan has been added to the Plan. The facility does not have a Dementia Waiver in place. A Hospice Waiver for 8 is approved. A fire clearance for 20 ambulatory and 68 non-ambulatory residents is in place. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place and expires 1/1/2024. Surety bond of $10,000.00 is current. Physical Plant/Environment Safety: The facility is a 2-story building located that is licensed for 88 elderly residents ages 60 and older. It consists of 45 resident rooms, 2 administrative offices, medication room, kitchen, dining room, caregiver room, 2 shower rooms janitor rooms, laundry room, electrical room, boiler room, 2 courtyards, and an activity patio located in the rear of the property. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Cleaning supplies and toxic substances are inaccessible to residents. On 9/27/2022 LA County Fire Department conducted a fire inspection. Fire clearance was denied pending corrections. Corrections were submitted on 11/4/2022, but facility has not obtained fire clearance verification. A call was placed during this visit. The fire inspector did not return the phone call. On 10/16/2022, R4 Fire Testing Services Inc. conducted an inspection to correct the violations identified in the Fire Department report. The sprinkler system, alarms, fire connections, and kitchen hood system were inspected. The facility has eight (8) fully charged fire extinguishers. Water temperature readings did not measured within the required 105 - 120 degrees Fahrenheit. Water temperature ranged between 101.6 - 109.9 degrees Fahrenheit. Maintenance staff cleaned the boiler during the inspection. However, circulation pumps need replacement. Rooms 108, 112, 127, 233, and 239 were missing window vertical blinds. Room 242's floors were dirty. Rooms 109 & 112 did not have Oxygen posters on the door. Signs were posted during the visit. Staffing: A total of 32 staff members provide care and supervision to the clients. Personnel Records/Staff Training: Administrator certificates expires 12/3/2023. Staff have criminal background clearance and training. Five (5) staff files were reviewed. Proof of staff training, health clearance, food handling certificates, and 1st Aid/CPR training are current. Resident Records/Incident Reports: A total of five (5) resident files were reviewed. They contained admission agreements, Physician's Reports, Appraisal, Individual Service Plans, TB clearance, Functional Capability Assessment, Physician's Orders, medical consent, medication records, and P & I money records. RCFE complaint poster and Personal rights were observed posted in the 1st floor hallway. The Incident report binder was reviewed. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. An activity calendar is posted by the dining room. The facility has a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Physician orders for modified diets are on file. Sanitation practices and kitchen cleanliness was observed. Incident Medical and Dental: Five (5) centrally stored resident medications were reviewed; containing 30-day supply of medications. Medical and dental transportation is provided. Disaster Preparedness: Emergency and Disaster Plan LIC 610E is in place, and evacuation chair at each stairway is in place. Records of resident Appraisal and Needs services plans are part of Emergency training. See next page Residents with Special Health Needs: Nine (9) residents are receiving home health services. One (1) resident receives hospice care. Postural support physician orders are on file. Half bed rails for mobility assistance were observed in some resident beds. Individual Service Plans and Appraisals are on file. No residents have prohibited health conditions. "No smoking In Use" signs were not posted on the resident doors. Per California Code of Regulations, Title 22, deficiencies were cited. Exit interview was conducted with Carmen Galicia. A copy of the report and appeal rights were issued.