Routine inspection·March 27, 2025

Licensing Program Analyst (LPA) De Leon conducted an unannounced required annual visit. LPA met with Caregiver, Liana Wati, who contacted administrator. Assistant Administrator Robert Santamaria joined the visit at 9:45 AM. The facility serves six (6) non-ambulatory elderly residents of which one (1) may be bedridden, ages 60 and above. Facility is approved for five (5) hospice residents. LPA use the Compliance & Regulatory Enforcement Tool (CARE) during today’s inspection. The visit consisted as follows: REVIEW OF FILES · Resident Admission Agreements, Resident & Staff files, Staff fingerprint clearance, Medications, Staff First Aid Certificate, Resident Physician reports, resident medical consent. FACILITY PHYSICAL PLANT · Four (4) resident bedrooms and one (1) office/staff room inaccessible to residents, two (2) bathrooms (only 1 used for residents), attached car garage, shaded outdoor area, living room, kitchen and dining room, and front and back yard. LPA reviewed three (3) staff files and four (5) resident files. Interview was conducted with one (1) staff and one (1) resident. Report continues on page 809C... Observations during facility tour: · Bedrooms were furnished with a bedframe, dresser, lamps, and chairs. LPAs observed that there was clean linen, bath towels, and personal hygiene with reasonable closet space available for residents. · Wall and floors are in good repair. Hallways were clean and free of obstructions. · Kitchen appliances were in working order and clean. There is sufficient two (2) days of perishables and seven (7) day supply of non-perishable. · Toilets, showers, and water faucets are found in compliance with Title 22 regulations for temperature and function. Restrooms were stocked and clean. · The water temperature was tested and measured. It was found in compliance with Title 22 regulations between 105º and 120º F degrees. · Sharps are locked in a closet and inaccessible to residents. Also, chemicals and toxics are locked and secured inaccessible to residents. · Smoke and carbon monoxide detectors were observed and are interconnected throughout the facility. One (1) fire extinguisher was observed and was fully charged with last inspection in April 2024. · Front and back yards are free of hazards and there were no bodies of water present at facility. Shaded area was available to residents. · First Aid kit was inspected and in compliance. · The medications are centrally stored and locked in a cabinet in kitchen. The facility uses the Medication Administration Record (MAR) log to document medications given. LPA reviewed medications for all six (5) residents. LPA observed the following deficiencies in the administration of medication. Prescribed medication for resident R2 was missed for three (3) out of six (6) medications (Amolodipine 5 mg, Quetiapine 50 mg, and Trazodone HCL 50 mg). Prescribed medication for resident R4 was not properly administer when needed for blood pressure (Midodrine HCL 10 MG). In addition, prescription was being administer to resident and bubble pack had been rupture but not properly log on the records for three (3) out five (5) Residents. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809D pages. Exit interview held and a copy of the report LIC9102 Technical Assitance, LIC809 and LIC809D along with appeal rights were provided to assistant administrator Robert Santamaria