Routine inspection·October 10, 2023

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 9:30 a.m., the LPA met with the Administrator and explained the reason for the visit. RECORD REVIEW: Between 9:45 a.m. and 11:00 a.m., the LPA conducted a file review for all residents and staff. Staff records were reviewed for documents including, but not limited to health screening, TB test, staff training records, and fingerprint clearance. The LPA could not identify staff records, including Administrator records. The Administrator’s Certificate expires 02/27/2024. In addition, the LPA was unable to identify the completed twenty (20) hours of annual training for the Administrator. The Administrator is in the process of hiring caregivers. No other staff records were presented. The LPA had several conversations with the Administrator with the goal of providing education in regard to staff records and training. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, and consent forms. The following was noted: One (1) out of four (4) residents with dementia diagnosis did not have updated physician’s report/ medical assessments. Four (4) out of four (4) residents require updated appraisals/needs and service plan. Additionally, the LPA requested updated copy of valid liability insurance and Facility Emergency Plan. At 12:46 p.m., the LPA, along with the Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. At 12:53 p.m., the LPA conducted interviews one (1) resident and attempted to interview an additional two (2) residents. KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 12:49 p.m., hot water measured at 96.1-degree Fahrenheit. The Administrator stated that they will adjust the water temperature between 105 and 120- degree Fahrenheit. Continued on LIC 809-C. BEDROOMS: The facility is a single-story residential home with five (5) bedrooms, three (3) for resident use and two (2) for staff use. The facility has three (3) bathrooms, one (1) for resident use and two (2) for staff use. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. The LPA had a conversation with the Administrator regarding the second staff room. The second staff room was built without a permit and the Administrator will obtain the building permit. RESTROOMS: Restroom is relatively clean and sanitary and in operating condition with grab bars and non-skid mats. At 1:02 p.m. hot water measured at 96.4-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. OUTDOOR SPACE: At 1:09 p.m., the LPA observed the back of the facility which has a covered outdoor area for resident use. There is a gate on the side of the house designated for an emergency exit. There is also a front gate that self-latches. There are no bodies of water on the premises. The garage is not accessible to residents. The Administrator did not have access to the garage during the time of the visit. The LPA observed a shaded sunroom with appropriate furniture and some exercise equipment. LPA observed enough space for residents to conduct some activities and exercise. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last purchased on 10/10/2023. Signs are posted throughout facility to promote handwashing, and cough/sneeze etiquette. Exit has functioning auditory devices. At 1:12 p.m., fire alarm/ carbon monoxide detectors were tested and functioned properly. Medications and first aid kits are located in a locked cabinet near the kitchen. Laundry units are located inside laundry room near the kitchen area. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away inside the laundry room cabinets. At 2:00 p.m., the LPA conducted a review of medication and medication documentation with the Administrator for four (4) residents and observed that all medications were properly documented. Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8 and California Health and Safety Code the following deficiencies were cited (refer to LIC 809-D). The Administrator was made aware that failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights was provided.