Routine inspection·May 6, 2025

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 10:07AM. LPA met with staff upon arrival and Administrator Mary Ann Howe who arrived at 10:51AM. Entrance interview conducted. At 10:11AM, the LPA along with staff, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: The LPA inspected the kitchen/food service area at 10:11AM. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and nonperishable food. Food labels were inspected and checked for expiration dates and food labels had expiration date clearly marked. Knives and chemicals were locked and inaccessible in the cabinet under the sink. At 10:22AM, LPA observed the auditory exit alarm in the kitchen not functioning during the time of the visit. Administrator stated that a new exit alarm will be installed. BEDROOMS: There are five (5) bedrooms total; two (2) are private resident bedrooms, two (2) are shared-resident bedroom, and one (1) is a staff room which is kept locked and inaccessible. Bedrooms #1, #3 and #5 have direct exits to the exterior. LPA observed resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, sufficient lighting, and equipped with functioning auditory exit alarms. At 12:15PM, LPA observed the bathroom door in bedroom #3 to have a hole on the bottom right corner by the hinge, leaving the framing exposed. Administrator stated that the door will be patched and a request for service had been made. Report Continued on LIC 809-C RESTROOMS: There are three (3) bathrooms for resident use; the full bathroom in the hallway is designated for staff and guests. Resident bedroom #1 and #5 have an attached Jack and Jill bathroom. Resident bedroom #3 has an attached bathroom for private use. Between 10:21AM-10:32AM, hot water temperature was measured in all three (3) bathrooms. Hallway bathroom measured at 117.5 degrees F, which is within the required range of 105-120 degrees F. However, hot water in bedroom #3’s bathroom and the Jack and Jill bathroom measured at 135.0 degrees F and 128.7 degrees F, respectively. Staff lowered the water heater during the visit. LPA re-measured at 12:19PM and hot water was 129.2 degrees F and 127.8 degrees F. LPA measured a final time between 02:22PM-02:26PM and hot water was 109.4 degrees F and 106.1 degrees F. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, common seating area and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common hallway. Fire extinguishers were fully charged and last serviced 05/03/2025. Administrator stated that service is scheduled for next week to re-new the fire extinguishers. The facility smoke alarm system is hard wired; the combination smoke and carbon monoxide detectors were tested at 10:48AM and were operable at the time of the visit. At 10:48AM, LPA observed the hallway smoke detector disconnected and placed on the hallway table. Staff stated that the smoke detector was disconnected on Sunday 05/04/2025 because the detector was beeping. Administrator stated that the detector was defective even after battery replacement and a new one will be purchased and installed by tomorrow 05/07/2025. LAUNDRY: At 10:25AM, LPA observed the laundry unit in the hallway by the staff room and bedroom #3. The door was unlocked and LPA observed detergents and cleaning solutions accessible to residents in care. Staff on shift did not have the code to lock the door. Administrator provided directions telephonically and staff locked the door during the visit. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water on the premises. There is a self-latching gate on the side of the house designated for an emergency exit. Passageways were free and clear from obstruction. At 10:34AM, LPA observed an unlocked and accessible shed containing cleaning solutions and detergents. Staff locked the shed during the visit. LPA observed a second shed that was locked and inaccessible containing additional supplies. Report Continued on LIC 809-C MEDICATION REVIEW: At 11:13AM, LPA reviewed medications for two (2) residents. Medications are centrally stored and locked in the hallway closet. All medications including PRNs were labeled, stored, and locked inaccessible to residents. PRNs were properly documented and logged. At 11:23AM, LPA observed Aspirin 81mg for Resident #1 (R1) missing two (2) pills that were unaccounted for. The medication is to be taken once a day and was started on 04/07/2025 with a quantity of thirty-one (31) pills, meaning that the medication should finish on 05/08/2025. However, the medication was fully finished with no documentation for the two (2) missing pills. At 11:41AM, LPA observed two (2) medications (Trazadone 50mg and Levothyroxine) missing start dates on the centrally stored medications and destruction record. RECORD REVIEW: Beginning at 02:28PM, LPA reviewed five (5) out of five (5) resident files and four (4) personnel files for documents including but not limited to: medical records, care plans, resident Admission Agreement, TB test, health screening, staff training, first aid certification, and fingerprint clearance. LPA observed two (2) resident files missing PRN authorization letters and consent forms. LPA observed one (1) resident without a half rail order and one (1) resident with full rails but not receiving hospice services. Administrator will obtain PRN authorization letters and half rail order and will amend the full rail order to half rails if the resident does not begin hospice services. LPA observed one (1) staff without fingerprint clearance. Administrator stated Staff #1 (S1) will obtain a live scan by tomorrow 05/07/2025. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control policy and emergency disaster plan. Emergency disaster plan is updated annually as required and emergency disaster drills are conducted quarterly as is required, with the last drill conducted on 03/10/2025. All documents reviewed were updated and in compliance. The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22. Civil penalties were issued in the amount of $1000. Administrator was informed that failure to correct deficiencies may result in additional civil penalties. Exit interview was conducted. A copy of the report and appeal rights were provided.