Routine inspection·November 7, 2024

Licensing Program Analyst (LPA) Sandra Urena conducted an annual required visit to the above noted facility. The LPA was greeted by staff. Staff contacted facility representative Emma Kochinyan, who arrived thereafter. The LPA and the 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. LPA reviewed physical plant findings with facility representative once the representative arrived at the facility. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. The facility maintained a comfortable temperature of 76 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. There is a fireplace in the living room, it was observed to be screened. There is a functioning telephone on the premises. The two (2) fire extinguishers were observed to have been purchased on 02/20/2023 and were expired at the time of today’s inspection. The LPA observed that the required postings were missing, except for the Facility License. Missing postings: Ombudsman Poster, Community Care Licensing Poster, Personnel Schedule (LIC 500), Resident Roster (LIC 9020), Residents’ Rights, and Facility Floor Plan/sketch. KITCHEN: Kitchen knives are stored inaccessible in a drawer to the right of the stove.The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The supply of nonperishable food is adequate. Appliances in the kitchen were clean and all appeared functional at the time of the visit. Trash cans had tight fitting lids. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. BEDROOMS: The facility has three (3) shared residents’ bedrooms. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Bedroom #1 had two residents at the time of the inspection. Continues on LIC 809C... BEDROOMS: Residents’ beds were observed to have full bed rails at the time of the inspection. Bedrooms’ number #2 and #3, were empty. Bedroom #2 was being used a staff’s bedroom at the time of the inspection. Facility representative stated that the night staff uses it for sleeping, since they haven’t had more than two residents since facility opened. The pre-licensing visit states that nocturnal (NOC), will be awake night staff only. There is no staff room designated in the facility sketch; consequently bedroom #2 cannot be used for staff use unless the facility licensee decides to make changes to the facility application. Facility representative has agreed to clean out the room. There was a linen closet in the hallway with extra towels and linens. BATHROOMS: There are two (2) bathrooms total. The resident bathroom(s) have a shower with non-skid materials. The toilet and shower have grab bars. The hot water temperature was tested in the bathrooms and the kitchen and was found to be within the range of 105*F and 120*F. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for client use. There is a side gate for client use and is single latched. The laundry room is located on the exterior of the house attached to the home. Cleaning supplies and toxins were observed stored and the room will be inaccessible to residents in care. The garage is located detached to the home, and the LPA observed supplies are stored in the garage. No bodies of water were observed. RECORDS: Records review began at 1:01 p.m., Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. One out of two residents’ files did not have updated required documentation. Personnel records were reviewed for, and were observed to be missing health assessments, criminal record clearances, first aid/CPR training, and the appropriate trainings. File for Administrator was not located at the facility. Two out of two staff files were missing: Health screenings/TB clearances, required 40-hour training, Criminal statement, Personnel Record, etc. MEDICATIONS : Medications review began at 1:50 p.m.; medications are centrally stored and locked in a cabinet in the kitchen area; medications are labeled and were checked for expiration dates. Medications were properly documented on the centrally stored medications and destruction record; for two out of two residents (Resident #1, Resident #2), the pill count was off during the medication audit. 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.Citations were issued. Exit interview conducted. A copy of the report was issued and Appeal Rights were issued.