Routine inspection·August 16, 2023

On 08/16/2023 Licensing Program Analyst (LPA) David España conducted an unannounced required annual visit. Upon arrival at the facility, LPA David España conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection. LPA David España verified that the facility has an approved mitigation plan report. The facility is licensed for six (6) non-ambulatory residents, of which one (1) may be bedridden and an approved hospice waiver for two (2) residents. Currently, there is one resident on hospice present during today’s visit. LPA met with the administrator, and both toured the inside and outside grounds of the facility. During the tour, LPA observed the facility’s infection control practices. PPE supplies are readily available to staff, and an additional 30-day supply of PPE is stored. Sufficient paper, cleaning, and disinfecting supplies were observed. The facility’s designated visitation area is in the back patio. LPA observed required postings at the front of the facility. The facility has one out of two residents with memory care needs. Potentially dangerous items, including sanitizers, are kept inaccessible to residents with dementia. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed. Furniture in the common area were in good repair. There are no security bars or weapons on the premises. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, the shower was free of mold/mildew. The water temperature measured between 105F-120F. A comfortable temperature was maintained in the facility. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxins were kept in a locked storage cabinet. Centrally stored medications were observed stored in their originally received containers and kept safe and locked and inaccessible to residents in care. One fire extinguisher was observed in the kitchen area. Outside grounds were toured. LPA observed a cascading pond in the backyard of the facility. The widest part of it is about 5 feet and the length is about 8 feet. The pond is about 2 feet deep with water that is inaccessible to residents in care. Pond was gated with hard wired. Walkways around the home were clear of hazards. Common areas were clean and clear of hazards; doorways were free of obstructions. There were deficiencies cited during this visit. Staffing - Technical Assistance: 1569.618(c)(3) - LPA David España and Licensee/Administrator, Sam Maghazei observed that renewed CPR training for staff was required at the time of visit on 08/16/2023. Resident Rights/Information - Type B: 87468(c)(2)(A) - LPA David España and Licensee/Administrator, Sam Maghazei observed that there was no PUB 475 at the front entryway of the facility at the time of visit. Disaster Preparedness - Type B: 1569.695(a) - LPA David España and Sam Maghazei, Administrator observed that the emergency and disaster plan is outdated and not current as of 08/16/2023. One technical advisory was discussed with Administrator. An exit interview was conducted, and a copy of this report and appeal rights was provided to Licensee/Administrator, Sam Maghazei.