Routine inspection·March 28, 2022

Licensing Program Analysts (LPAs) Luis Mora, Mary Flores and Investigator Tiffany Brunelli from Investigation Bureau (IB) conducted an unannounced annual visit at the facility with focus on the infection control domain, medication and food review. LPA Mora met with Caregiver Fresmida Vizcarra and explained the reason for the visit. The facility is licensed to serve 6 non-ambulatory residents age 60 and above. Facility has a dementia waiver and are allowed to care for 1 resident on hospice at any one time. The facility is located in a residential area. A tour of the single-story facility included: administrator office room, kitchen, living room, family room, dining room, 6 resident rooms, caregiver room, 3 resident bathrooms, 1 staff bathroom, attached garage, front yard and backyard. LPA and Fresmida Vizcarra toured the facility and the following was observed: The front and backyard are well maintained. There is a pool in the backyard surrounded with a locked fence. There is a shaded seating area for the residents located in the backyard. Passageways and exits are free of obstruction. Auditory devices were seen on exit doors which are required for dementia residents and were operating at the time of the visit. The water temperature was tested in the all 3 of the residents’ bathroom and measured at 109.4, 110.5, 105.6 degrees F which is within the required 105 - 120 degrees F. The bathrooms are clean and have the required grab bars in the shower and near the toilet for non-ambulatory residents. Showers also have non-skid materials. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have enough closet space. Resident beds have the required linen and the linen is in good condition. There is extra clean linen in a closet located in the family room. There are extra clean towels in each bathroom. There are extra hygiene products in a hallway closet. Two bottles of Lysol spray, a Clorox wipe container, and a bottle of hydrogen peroxide were observed with the hygiene products in the closet which is not locked. Smoke detectors were observed in each room and throughout the facility and are properly operating. There are 2 carbon monoxides in each hallway and are properly operating. There is 1 fire extinguisher located in the kitchen which are fully charged. Kitchen appliances are clean and were operating at the time of the visit. (CONTINUED TO LIC 809C) Sharps are kept locked in a kitchen cabinet and are inaccessible to residents. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen and in a refrigerator located in the garage. Cleaning supplies and toxins are kept locked in the garage and are inaccessible to residents. First Aid kit was fully stocked with current manual and it is kept locked in the residents’ medication cabinet in the family room. Residents medication are centrally stored in a locked cabinet in the family room. Residents and staff files are centrally stored in the administrator office room. LPAs reviewed all 6 of the residents’ medication and files, and 6 staff files. LPA observed 3 out of the 6 resident files did not have a current physician report. LPA observed 1 of the residents did not have a physician written request for the PRN medication and 2 of the residents PRN medication did not have labels on them. LPA observed all 6 of the staff did not have a valid First Aid/CPR certificate in their file. Facility is following COVID 19 recommendations regarding screening visitors, staff, and residents. Signs are posted throughout the facility, and hand-washing signs were observed in bathroom. Sufficient hand soap, hand sanitizer, and paper towels were observed. Supply of 30-day Personal Protective Equipment (PPE) was observed in the administrator office room. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were deficiencies observed during the visit and a civil penalty was assessed (refer to LIC 809D & LIC 421FC). Exit interview held and a copy of the report and appeal rights were provided.