Routine inspection (multi-day)·May 22, 2024

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced at 9:00 AM for a Case Management – Annual Continuation inspection. The LPA met with facility supervisor Omowunmi Balogun and explained the reason for the visit. During the Required 1-Year on 03/15/2024, the LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility compliance of Title 22 Regulations. Physical plant tour was conducted during the Annual visit. Today, 05/22/2024 a brief tour was conducted. No health and safety concerns were identified during today's tour. Facility has a sprinkler system in place, last inspection report was conducted on 12/08/2022 with an expiration date of 09/30/2024. Test result “Pass”. RECORD REVIEW: Began at 10:12 AM, staff and resident records were reviewed for documents including, but not limited to; admission agreement, health screening, TB test result, resident physician's report, needs and service appraisal, and personal rights. Five (5) out of five (5) resident records reviewed were missing consent forms and need and service plan. During the visit, the supervisor was able to complete all five (5) needs and service plan without resident’s signatures. Supervisor agreed to submit all completed and signed forms to LPA once each resident signs it. LPA reviewed five (5) staff files for documents including but not limited to staff training records, fingerprint clearance, health screening and TB test result. Record review and interview conducted revealed Staff #1 (S1) was employed by the company in March of 2023. S1 is working for this facility at least 20 hrs. per week. LPA reviewed the facility guardian roster and discovered that S1 does have fingerprint background clearance but is not associated to this facility. Continued on LIC 809-C Continued from LIC 809 MEDICATION REVIEW: LPA conducted a medication review for five (5) residents with the facility supervisor between 12:25PM and 1:28PM. LPA observed the following three (3) medication discrepancies were noted. For Resident #1 (R1) LPA observed five (5) pills of Levothyroxine, in a bottle labeled with quantity of 90 pills, with instructions to take 1 tablet orally daily, and with a start date on documentation as 04/01/2024. Resident #2 (R2) had four (4) extra pills of Aspirin in a bottle labeled with quantity of 30 pills, with instructions to take 1 tablet orally daily, and with a start date on documentation as 05/01/2024. Resident #3 (R3’s) pill count reflected three (3) extra pills of Spironolactone in a bottle labeled with quantity of 30 pills, with instructions to take 1 tablet orally daily, and with a start date on documentation as 05/01/2024 and an additional five (5) extra pills of Spironolactone in a bottle labeled with quantity of 30 pills, with instructions to take 1 tablet orally daily, and with a start date on documentation as 05/01/2024. Staff could not provide an explanation for the discrepancy. EMERGENCY DISASTER PLAN and Quarterly Drills: During today's visit, LPA reviewed the facility's infection control plan, Emergency drills, and Emergency Disaster Plan. All facility's policies and procedures related are adequate. The facility's Emergency Disaster Plan is complete and updated annually. Emergency drills are conducted quarterly, with the last drill taking place on 03/16/2024. Staff checks smoke detectors monthly, last test was 05/04/2024. Per the California Code of Regulations, Title 22, Division 6, Chapter 8 the following deficiencies were observed and cited. Refer to the following LIC 809-D pages for list of deficiencies. Civil penalty issued in the amount of $500. Failure to correct deficiencies may result in additional civil penalties. Exit Interview Conducted. Report was reviewed with Supervisor, and a copy of the report and appeal rights were provided.