Routine inspection·February 3, 2023

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 02/03/2023 at 1:30pm. LPA was met by John Michael Tanada and explained the purpose of the visit. Facility is licensed to serve 50 Ambulatory and 30 Non-Ambulatory residents (age 60 and above). LPA requested and obtained a copy of Personnel Report (LIC 500), Resident Roster (LIC 9020), copy of Liability Insurance and 3 resident Medication Administration Record (MAR). Resident rooms #1 thru #19, Room #24, Room #30, and Room #38 are cleared for non-Ambulatory residents only. Facility is approved for 8 hospice residents. LPA OBSERVATIONS: Tour was given by Administrator Tanada at 1:45 pm. Kitchen, pantry, laundry room, centrally stored medications room, 4 randomly selected resident rooms (Room# 14, 16, 23, and 27), Shower room # 4, Visitor bathroom, patio area, and TV/Day room were inspected. · TV/Day Room: Was clean and had sufficient seating for residents and visitors. · Kitchen/Pantry: LPA observed kitchen to be clean and appliances appeared to be in working order. LPA observed sufficient 2 days of perishables and 7 days of non-perishables. Kitchen sink water temperature was measured at 106.0 degrees F. Signs promoting hand washing and social distancing were observed. · Dining Room: Dining room area was clean; chairs were spaced out to promote social distancing. Signs promoting social distancing and cough/sneeze etiquette were not observed throughout dining area. LPA will issue Technical Advisory. · Laundry Room: Was secured an inaccessible to residents. Room was observed to be clean and organized. LPA observed sufficient linen and towels. · Resident Rooms: Resident room #14 was observed to be clean and contained the required furnishings and linens. LPA was unable to measure water temperature in bathroom due to it being occupied by resident. Resident room #16 was observed to contain the required furnishings and linens. At 2:01 pm LPA observed resident bathroom# 16 toilet to be dirty and contain stains on seat. Base of toilet was observed to contain dirt and grime. Sink was observed to be dirty and contain grime around rim. Water temperature was measured at 106.1 degrees F which is in the required 105 – 120 degrees F. No paper towels were observed in bathroom. Resident room #23 was observed to be clean and contained the required furnishings and linens. At 2:10 pm LPA observed two 21 oz cans of Comet Bleach powder cleaner on bathroom window. This poses an immediate health, safety, or personal rights risk to persons in care. Administrator Tanada removed cans of bleach and secured them in storage area. Water temperature in resident bathroom # 23 was measured at 107.4 degrees F which is in the required 105 – 120 degrees F. No paper towels were observed in bathroom. Resident room #27 was observed to be clean and contained the required furnishings and linens. Water temperature in resident bathroom # 27 was measured at 105.6 degrees F which is in the required 105 – 120 degrees F. No paper towels were observed in bathroom. · Visitor Bathroom: Water temperature in bathroom was measured at 106.5 degrees F which is in the required 105 – 120 degrees F. LPA observed sink to contain grime and dirt. · Shower Room #4: Was observed to contain a non-slip mat and was observed to be clean. · Centrally Stored Medications: At 2:20 pm, LPA discovered 3 resident medication administration record (MAR) was initialed by staff when the resident had not yet taken dosage. Resident #1 (R1) MAR indicated on 02/03/2023 at 8pm, R1 consumed 2 Divalprolex 500mg tablets orally at bedtime. This poses an immediate health, safety, or personal rights risk to persons in care. Resident #2 (R2) MAR indicated on 02/04/2023 at 8am, R2 consumed 1 Pantoprazole Sodi 40mg orally, at 8pm R2 consumed 1 Simvastatini 10 mg orally at bedtime and 1 Amlodipine Besylate 10 mg orally at bedtime. This poses an immediate health, safety, or personal rights risk to persons in care. Resident #3 (R3) MAR indicated on 02/03/2023 at 8pm, R3 consumed 1 Quetiapine Fumarate 100 mg orally at bedtime, 1 Zolpidem Tartrate 10 mg orally at bedtime, 1 Donepezil HCL 10 mg orally at bedtime, and 1 Gabapentin 100 mg orally at bedtime. This poses an immediate health, safety, or personal rights risk to persons in care. Administrator certificate was observed for John Michael Tanada with an expiration date: 09/27/24. Last fire drill was conducted on 01/06/2023 Technical advisories and deficiencies were cited during visit. Exit interview was conducted with Administrator Tanada and a copy of this report, LIC 809D, LIC 9102, and appeal rights were provided.