Routine inspection·February 23, 2024

At 10:10 a.m. Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit. The LPA was greeted by House Manager Blaire Soriano and informed them of the reason for the visit. Administrator Michelle Maurer was unable to be present during the visit and authorized Blaire Soriano to review and sign the report. At 10:26 a.m. the LPA conducted a tour of the physical plant with the House Manager to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: Facility is a single-story residence that consists of five (5) resident bedrooms, and two (2) restrooms. The LPA observed one (1) fire extinguisher which was fully charged and last purchased on 09/21/2023. All smoke alarms and carbon monoxide detectors were tested and functioned properly. The LPA observed all required postings in the hallway near the entrance area. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. Kitchen : At 10:32 a.m. the kitchen appeared clean and the appliances and fixtures functional. The LPA observed a sufficient amount of perishable and non-perishable food at the facility. Food is prepared based on the menu. Snacks and beverages are always available for the residents. Bedrooms: The resident bedrooms were properly furnished with at least one chair, nightstand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding. The LPA observed bedrooms #2, #3 and #4 with exit doors obstructed. Bedroom #2 had a nightstand and a chair obstructing the exit door to the outside. Bedroom #3 had a dresser and a portable ventilator obstructing the exit to the outside, and a nightstand obstructing the door between bedroom #3 and bedroom #4. The door between bedroom #3 and #4 is an exiting door for bedroom #4. Report will continue on LIC809-C. Bathrooms: The LPA observed all bathrooms, properly supplied, and had functional fixtures. The LPA observed grab bars and non-skid floors in all bathrooms. At 10:44 a.m. water temperature in the outside restroom was measured at 128.9 degrees Fahrenheit. At 10:58 a.m. water temperature in the resident’s restroom in room #1 was measured at 127.2 degrees Fahrenheit. Common Areas: These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. There is a fireplace in the living room, which is covered with a screen. The garage: The LPA observed the garage where the washer and dryer are held. The garage is used as storage. The garage is locked. Surrounding Grounds (Outdoors) : The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There are no bodies of water on the premises. Record Review: At 11:07 a.m. a review of facility files was initiated. Facility records are stored in a locked closet. The LPA observed documentation of Infection Control, Disaster prevention and last fire drill (conducted on 02/05/2023). The LPA obtained Client Roster, Staff Roster, and Insurance Liability. The LPA reviewed five (5) out of six (6) resident files. Files were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. The Appraisal/Needs and Services Plans (ANS) for one resident was noted with two dates, the LPA could not verify if the ANS was from 2023 or 2022, however the House Manager confirmed it was dated 2023. Otherwise, all resident records were in order. The LPA reviewed five (5) of seven (7) staff files. Staff files and Administrator’s file were reviewed for, but not limited to personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. The LPA identified that one (1) of five (5) staff did not have TB test results on file. Otherwise, all staff records were in order. I nterviews: The LPA conducted two (2) resident Interviews and two (2) staff interviews. No immediate concerns were voiced. Medications: At 2:30 p.m. a medications review was initiated for two out of five residents and the following was observed. The medications were stored in a locked closet and inaccessible to the residents. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. During Resident #1 and Resident #2 ‘s (R1, R2) audit, the LPA observed PRN medication for both residents, however the LPA did not observed a PRN authorization letter from their physicians. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report and appeal rights provided.