Routine inspection·September 3, 2024

This is an amendment of the original report issued 09/03/2024. Based on 2 nd level appeal response deficiencies 87705(c)(4) and 87204(a) have been dismissed. Licensing Program Analyst (LPA) Lorena Casillas met with administrator Monica Gory for an unannounced one (1) year Required visit for this facility. LPA arrived at 10:00 am and was greeted by a caregiver. Caregiver called administrator and LPA was informed that administrator was on their way. LPA informed the Administrator of the purpose of the visit via phone. Six (6) out of the six (6) residents were observed to be in their room sleeping, watching TV and/or resting. There is only one (1) staff member for care in the facility. The Administrator arrived at 02:45 pm. Infection control: LPA previously reviewed the facility mitigation plan (approved on 03/ 1 8/21) to make sure the licensee was following current infection control recommendations. A tour of the physical plant was conducted with caregiver at 10:20 am. The facility has five (5) bedrooms and two (2) bathrooms currently occupying six (6) residents. One (1) bedroom is designated for staff use only. The facility is Fire Cleared for four (4) ambulatory, two (2) non-ambulatory, and a hospice waiver for one (1). Currently the facility has no residents on hospice. Food Inspection: LPA conducted a tour of the kitchen 10:20 am and observed there to be sufficient stock of two-day perishables and seven-day non-perishables foods. Frozen foods are properly wrapped and stored. Food storage and preparation areas care clean and inaccessible to pests. LPA observed all knives and sharp objects being locked and inaccessible to residents in care. The Medication cabinet was in the kitchen and was observed to be locked and inaccessible to residents in care. Continued on LIC809-C Resident Rooms: LP A observed rooms to have the appropriate bedding. There is a nightstand, a chair and sufficient lighting for each client . LPA observed the staff room to have a locked filing cabinet for staff and residents’ files. Currently the staff office has an extra freezer, and extra supplies. Bathrooms: At 10:30 am LPA observed all bathrooms to have non-skid mats, grab bars, and the appropriate wash your hands signs posted. Hot water was tested and measured within regulation at 115.0 degrees F. Living and dining: LPA observed the living room to be neat and clean along with the dining room. The facility maintains a temperature of 78°F. The dual smoke detectors and carbon monoxide detectors were tested and observed to be operational at 11:40 am. There are two (2) fire extinguishers, one (1) is in the kitchen and one (1) is in the hallway. The Fire extinguishers were observed to be full and last serviced on 10/29/2023. Laundry: LPA observed the laundry room to not have any chemicals or hazardous items. Cleaning supplies are kept locked in a hallway closet outside of laundry room. Physical environment: LPA toured the outside area of the facility at 11:00 am. LPA observed appropriate outdoor furniture, with a covered shaded area for clients . No bodies of water on the premises. Garage: LPA observed no garage. Administrative: Annual fee is current. LIC 500, Client roster and Liability insurance will be emailed to LPA today. Resident Files : LPA conducted a file review of resident records at 2:30 pm. Based on record review, facility is over capacity for non-ambulatory residents by one (1) resident. Civil penalty shall be issued. Facility will also be issued a citation for having one (1) non ambulatory resident in ambulatory rooms. Based on file review, a citation for not having sufficient staff will also be issued. Staff Files : LPA conducted a file review of staff records at 03:00 pm. Medications : At 4:00 pm LPA and Administrator reviewed medication and medication records. Citation issued. Civil Penalty issued (see LIC809-D). Appeals rights discussed and provided. Exit interview was conducted, and a copy of this report was emailed to the Administrator.