Routine inspection·August 17, 2022

Licensing Program Analyst (LPA) Joe Katrdzhyan conducted a site visit for the Required - 1 Year inspection. Upon arriving at the facility, LPA met with Executive Director / Andrew Smith and was later joined by the Director of Wellness / Sev Tienda, who assisted with the visit. The facility is licensed to serve for a capacity of two hundred (200) Non-ambulatory residents ages 60 and above. The facility has an approved Hospice Waiver on file for six (6) residents. The facility also has an approved Dementia Care plan as part of their operation. This is a Continuing Care Retirement Community (CCRC) which includes two separate levels of care; Independent Living and Assisted Living. The Assisted Living residents are located in the Memorial Lodge (ML) and Shu Lodge (SL). Memory Care residents are located in the Hacienda Building. There are currently 24 residents residing in Assisted Living, 9 residents in Memory and 127 residents in Independent Living. The facility does NOT have a bedridden fire clearance. During today's visit, LPA used the infection control domain to complete the Required - 1 Year inspection. Also, the physical plant was toured, medications and food supplies reviewed. LPA 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. During the tour, LPA was accompanied by Mr. Tienda and Director of Grounds / Gary Walter. LPA toured a random selection of resident rooms. Resident rooms were furnished appropriately. Each resident room has their own bathroom. The bathrooms were observed to be clean and operational w/grab bars. The hot water temperature was tested throughout the facility and measured within Title 22 Regulation guidelines. The facility has central air and heating accommodations. The front grounds of the facility are well landscaped and have a leveled walkway to the entrance. There are various yard areas throughout the facility that are equipped with patio furniture for resident comfort and safety. (Please see LIC 809C for additional information) Facility has a working landline. The kitchen was observed. There was a sufficient amount of perishable and non-perishable food supplies. No pesticides or poisons were stored in the food areas. Medications are centrally stored and locked in each of the lodges/buildings stated on this report. All required information (COVID-19, Emergency Exiting Floor Plan, Personal Rights, Ombudsman information, Theft and loss policy and Emergency Telephone Numbers) are posted in the facility. During today's walk through, LPA observed COVID-19 prevention/protocol signs posted throughout the facility. LPA reviewed resident medications. The following concerns were observed during today's visit; At 11:42am, LPA found a scissor in the kitchen cabinet located at the Hacienda Building, left accessible to memory care residents. At 11:50am, LPA tested the delay egress doors (two doors) located inside the Hacienda building and once the doors opened and the alarm sounded off, facility staff were unable to deactivate the noise using the key pad, located by both delay egress doors. The noise sounded off until maintenance had to disconnect the wires. At 12:05pm, LPA discovered that medications Atenolol 50 mg tablet (50 mg by mouth once daily), Losartan 25 mg tablet (25 mg by mouth daily), Simvastatin 10 mg tablet (10 mg by mouth once daily) and Vitamin B-12 1,000 mcg tablet (1,000 mcg by mouth once daily) were missing from the facility and not being administered to Resident 1 (R1), by facility staff, per physician's instructions. The following deficiencies were observed to be in violation of California code of Regulations, Title 22, Division 6 (refer to 809D) An exit interview was conducted and a copy of this report was provided along with the Appeals Rights.