Routine inspection·September 12, 2023

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to Administrator Chona Cruz. There are currently 6 elderly Dementia residents 60 years and older residing in the facility. One (1) resident is receiving hospice care, and two (2) residents receive home health services. The inspection was completed using the CARE tools. Twelve (12) CARE tools domains were reviewed. Infection Control: Visitors are still screened for COVID-19 and required to sign in. The facility has an Infection Control Plan and Covid-19 Mitigation Plan. Infection control practices and Personal Protective Equipment (PPEs) were observed. Operational Requirements: A current Plan of Operation was reviewed. The facility has a Dementia Waiver in place. A Hospice Waiver for 5 is approved. A fire clearance for 6 non-ambulatory adults 60 and over is in place. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current and expires 6/29/2024. A surety bond is not applicable. Facility does not handle resident's money. ***See next page for report narrative.*** Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood consisting of 4 resident bedrooms (2 shared and 1 private), 1 staff room, 3 bathrooms, living room, dining room, kitchen, laundry room, outdoor patio area with patio furniture, and 2 car detached garage presently being used as storage room. Staff room next to resident room #4 is being renovated. Resident room # 5 is presently being used as a live-in staff room for staff (S2 & S3). The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Kitchen drawers containing knives/sharp objects were locked. Two bathrooms had unlocked incontinence care/mouth wash, medicated body powder, hand sanitizer, and disinfectant cleaning supplies. Citation was issued. The backyard and side yards had unlocked sharp tools, gardening supplies, paint can, insect/roach spray, and kitchen cleaning products. Citation was issued. The facility has two (2) fully charged fire extinguishers and a fire pull alarm. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. Water temperature ranged between 101.6 - 109.9 degrees Fahrenheit. Staffing: A total of 8 staff provide care and supervision to the clients. Personnel Records/Staff Training: Administrator certificate expired 1/24/2023. Licensee/Administrator provided proof that training was submitted to certification unit and is awaiting receipt of current certificate. Personnel files were reviewed. Criminal Background Clearance, staff training, 1st Aid/CPR, and health screening/TB clearance was checked. Resident Records/Incident Reports: A total of three (3) resident files were reviewed. Dementia resident (R1's) Physician Report is not updated. Citation was issued. RCFE complaint poster and Personal rights were observed posted in the facility entrance area. ***narrative continues next page*** Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Minimal indoor and outdoor activities are performed. The facility does not have a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Physician orders for modified diets are in place. Incident Medical and Dental: Centrally Stored Records for medications are kept. Facility does not use Medication Administration Records (MARs). The facility does not have resident (R1's) PRN Acetaminophen 500 mg medication, and the centrally stored record is missing prescription #, date of Rx, and expiration date. Citation was issued. Medical and dental transportation is provided by family members. Disaster Preparedness: Emergency and Disaster Plan LIC 610E is in place and was posted today. The last emergency disaster drill was conducted on 7/14/23. Residents with Special Health Needs: One (1) resident receives hospice care and two (2) residents are enrolled in home health services. Hospice Care Plan was reviewed. Postural supports/ Hoyer lift is used by one resident. Physician order is on file. Full and half bed rails for mobility assistance were observed in resident beds. No residents have prohibited health conditions. Per California Code of Regulations, Title 22, deficiencies were cited. Exit interview was conducted with Administrator Chona Cruz. A copy of the report and appeal rights were issued.