Routine inspection·March 9, 2024

Licensing Program Analysts (LPAs) Martha Arroyo and Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 3:02 PM, LPAs met with the Administrator, Anna Bernice D Lee and explained the reason for the visit. Entrance interview. At 3:04PM the LPA along with the Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and that the facility is in compliance with Title 22 Regulations. The following was noted: The facility is a single-story residential home with nine (9) bedrooms, six (6) for resident use, five (5) bathrooms, and three (3) staff rooms, two (2) of which are inside the Attached Accessory Dwelling Unit (ADU). BEDROOMS: The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. LPA observed a hallway closet with extra towels and linens for resident use. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. Starting at 3:11PM, the hot water temperature was measured in four (4) resident bathrooms, and they measured between 105.3- and 113.5-degrees Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. Continued on LIC 809C... Continued from LIC 809... KITCHEN: The LPAs observed the kitchen and dining area. Knives are stored in a locked drawer inaccessible to residents in care. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Food labels were observed for expiration dates. At 3:10PM, the kitchen faucet was measured at 108.6 degrees Fahrenheit. A first aid kit is located near the kitchen. OUTDOOR SPACE: At 3:04PM, the LPA observed the back patio which has a covered outdoor area with a table and chairs for resident use. There are two gates on each side of the house designated for an emergency exits. The property is gated. Passageways were free and clear from obstruction. There are no bodies of water on the premises. Laundry units and laundry detergents are located in the ADU which are kept inaccessible to the residents. COMMON AREAS: The LPAs observed common areas to be relatively clean and properly furnished. The LPAs observed the fire extinguisher to be fully charged and last serviced on 10/12/2023. At 3:20PM, fire alarms/carbon monoxide detectors were tested and functioned properly. All exits have functioning auditory devices and were operational at the time of the visit. Facility telephone was observed during the time of the visit. LPAs observed cameras in the common areas, and throughout the exterior perimeter of the facility. Night lights were present in the hallways. Cleaning solutions, chemicals and hazardous items were inaccessible and locked away inside a locked bathroom closet. RECORD REVIEWS: Starting at 3:05PM, the LPAs conducted a file review for all residents and staff regularly scheduled and observed the following: Staff have current first aid and training documentation showing required training completed. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, and consent forms. Continued on LIC 809C... Continued from LIC 809C... At 3:41PM, records review of R1’s physician’s report, dated 01/31/2024, lists R1 having no capacity for self-care which is a prohibited health condition. At 4:35pm, the Administrator printed updated physician’s report, dated 02/08/2024, which lists R1 is able to feed themselves. Staff files were complete. The Administrator’s certificate is active and expires on 01/11/2025. The LPAs requested a copy of valid liability insurance and Facility Emergency Plan and Infection Control Plan. The last emergency disaster drill took place on 03/01/2024. During the time of the visit, the LPAs conducted interviews with one (1) resident. At approximately 4:08PM, the LPAs conducted a review of medication and medication documentation with staff for five (5) residents. Medications are centrally stored and locked in a closet by the main entrance hallway. At 4:16PM, medication review of R2’s medication revealed that medication Mirtazapine Tablets, USP, 30 mg is missing the prescription label as the medication box which had the prescription label was discarded; therefore, LPAs were unable to determine if medication is being administered as prescribed by physician/pharmacy. Staff state they will make sure they do not discard medication box with prescription label in the future. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were issued.