Routine inspection·October 26, 2024

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Maria Madrigal and explained the reason for the visit. The facility is licensed to serve 17 non-ambulatory residents over the age of 60 with a hospice waiver for 2. The facility is located in a residential neighborhood and is composed of (6) single story cottages each have (2) bedrooms and (1) bathroom, cottage #39 has 2 bathrooms, dining room/kitchen area, staff bathroom in living room area, (3) office space, medication room, and a courtyard area. LPA conducted a tour of the facility with Natividad Vargas - Staff and observed the following: Facility is in good repair indoor and outdoor. Dining/Kitchen area was observed clean, with an exit door to passageways. Sufficient food supplies for at least 2 days of perishables and 7 days of non-perishables were observed. Cleaning supplies were observed under the kitchen sink and was not lock at the time of the visit. Sharps were locked in a kitchen's drawer. Facility has Local Ombudsman and license posted in the dining room. Let-Us-Know PUB 475 and personal rights were not observed posted. LPA observed a total of 12 bedrooms each have the required furniture and bedding supplies, and sufficient lighting. A total of 7 resident bathrooms were observed in working condition, 6 out of the 7 bathrooms did not have skid mats/strips, grab bars were observed, water temperature was tested as follow: cottage #39, bathroom#1 at 135.2 degrees F., bathroom #2 at 143.8 degrees F., cottage #37 at 127.6 degrees F., cottage #35 at 117.9 degrees F., cottage #33 at 125.2 degrees F., cottage #41 at 130.1 degrees F., cottage #43 at 130.6 degrees F. Resident #5'(R5)s bedroom has an exit door to passageway with exit and does not have a sound device at door as R5 has a dementia diagnosis. Residents beds had half bed rails, except for resident #1(R1) and empty beds. Courtyard has (2) exit doors which do not have sound devices. No large bodies of water were observed. Facility has a fire sprinkler system throughout. Fire extinguishers were observed and last checked on 11/29/23. (CONTINUED ON LIC 809C) LPA reviewed medication and files for 5 residents. Residents #3-#5(R3-R5) have dementia diagnosis and their last physician's report were noted in order as follow: 6/12/19, 11/9/21, 2/15/21. R3 and R5 do not have a TB test clearance on file. There were no bed rail request on file for any of the residents. LPA reviewed 4 staff files. Administrator certificate on file #6017793740 exp. date: 6/26/14 was observed. LPA reviewed department's website to see if there is a current or pending application and no records were found. Staff #1-4(S1-S4) last CPR certificate expired in 2019. S3-S4 did not have a health screening or TB test on file. S2-S4 did not have records of training within the last 12 months. LPA reviewed Emergency Disaster plan. Last fire drill was conducted on 10/11/19. Infection control plan was not available for review. Liability insurance was observed. LPA interviewed 3 staff and 3 residents. Deficiencies were noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Patricia Garcia Manager and a copy of this report, LIC 809D, and appeal rights were provided.