Routine inspection·May 2, 2023

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 05/01/2023 at 12:30 pm. LPA was met by Staff S2 and explained the purpose of the visit. Administrator Hongwei He later arrived to assist in tour. Facility is licensed to serve elderly residents over the age of 59 and is licensed to serve residents with dementia. The facility may retain 1 bedridden resident and 5 non-ambulatory residents. Waiver is approved for 1 hospice resident although, the facility currently does not have a hospice resident in care. LPA requested and obtained a copy of Resident Roster (LIC 9020). LPA OBSERVATIONS: Tour began at 12:53 pm and was led by Administrator He. The Facility is a single-story dwelling located on a residential street. The facility consists of five (1) client bedrooms, two (2) shared bathrooms, one (1) staff bedroom, living room, kitchen, dining room, front yard, and backyard. · Front Yard: Was clean and well maintained. No hazards were observed. · Kitchen: LPA observed kitchen appliances to be in working order. LPA observed sufficient 2 days of perishables and 7-day supply on non-perishables. Kitchen sink water temperature was measured at 107.6 degrees F. LPA observed kitchen cabinet located near stove, containing knives and sharps, to be accessible to residents in care. LPA observed a padlock on cabinet, but no locking mechanism was placed to secure cabinet. When LPA questioned staff, staff stated they could not find lock at this time. LPA observed kitchen sink cabinet containing insect/bug spray and cleaning solutions to be accessible to residents in care. LPA observed a padlock on cabinet, but no locking mechanism was placed to secure cabinet. Kitchen walls and ceiling were observed to contain light reddish/orange splatter, stove backsplash contained caked grease and dirt, surrounding stove cabinets above and below contained cake grease and dust bunnies, stove venting was observed to be dirty and contained caked grease, kitchen floors were observed to be dirty and sticky. · Dining Room/Living room: Dining room was observed to be clean and contained one table and 4 chairs. Living room was observed to contain plenty of seating, and plenty of lighting. LPA observed front door screen to be torn by handle. Resident Bedrooms 1 - 4: All contained the required furnishings, linens and were observed to be clean. Auditory devices located in resident rooms were not in “ON” position. · Resident Bathrooms# 1-2: Were observed to contain soap, and paper towels. Signs promoting handwashing were observed. Water temperature in bathrooms were within the required 105 – 120 degrees F. Grab bars observed near toilet and showers. Showers and bathroom floors were observed to contain caked dirt and grime. Toilet bowls in both bathrooms were observed to contain dirt and yellowish stains around the rim of the toilet bowl. LPA observed one (1) walker and two (2) folding commodes being stored in resident bathroom #2. Bathroom sink in shared resident bathroom was observed to contain a white build up around the sink knobs. · Centrally Stored Medications: LPA observed medications cabinet located in dining room area to be inaccessible to residents in care. LPA was unable to review resident Medication Administration Records (MAR) and prescribed medications due to facility not recording dosages for the month of May 2023. LPA observed carbon monoxide in hallways. Smoke detector is hard wired and tested during visit. LPA could not verify last emergency drill due to facility not documenting last drill. LPA reviewed staff files and resident files. Deficiencies are being cited during visit. Exit interview was conducted and a copy of this report and appeals rights was provided via email due to printer problems.