Routine inspection·August 22, 2024

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 9:45AM. LPA met with Head Caregiver (HC) Dexter Olavario. Administrator Belinda Dolinsky could not be on site at the time of the visit, but Dexter Olavario was designated to sign in their place. Entrance interview conducted. Beginning at 9:52AM, the LPA, along with the HC toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: Fire extinguishers are fully charged and were last serviced 06/06/2024. Hardwired smoke detectors and carbon monoxide detector in kitchen were tested at 11:17AM and all were functional at the time of the visit. LPA observed exit alarms by all doors which were functional and operating. COMMON AREAS : This includes the living room, physical therapy room, and dining room. LPA observed common areas to be clean and properly furnished at the time of the visit. At 09:53AM, LPA observed a fireplace in the living room not appropriately screened. Facility is maintained at a comfortable temperature. LPA observed surveillance cameras in the common areas. LPA observed storage space closets in hallway containing clean linens for resident use. BEDROOMS : The facility consists of eight (8) total bedrooms, of which six (6) are designated for single-resident use and two (2) are designated for staff use. All resident rooms have exits to the exterior. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Staff bedrooms were observed and were occupied by staff. Report Continued on LIC 809-C BATHROOMS : There are six (6) total bathrooms, of which five (5) are attached to resident rooms and 1 (one) is for common use. Restrooms were observed to contain nonskid mats and grab bars by the showers and toilets. Water temperatures in resident bathrooms were measured between 138.0 and 142.1 degrees Fahrenheit between 09:58AM-11:22AM, which is outside of the required range. LAUNDRY ROOM: LPA observed the laundry room adjacent to the staff rooms. Laundry room has a washer and dryer and locked cleaning supplies. KITCHEN/GARAGE: LPA inspected the kitchen at 10:05AM. Knives and sharps are stored in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed emergency food and water supply in the pantry next to the kitchen. Food was stored at appropriate temperatures. The locked garage is accessed through the kitchen. LPA observed an additional refrigerator/freezer and cleaning supplies in the garage. OUTDOOR SPACE: The backyard has a covered patio area with furniture including a table and chairs. There were no bodies of water on the premises. One (1) side pathway is used as an emergency exit which was free of obstruction and had a self-closing and self-latching gate. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually as required. Emergency disaster drills are conducted quarterly as is required, with the last drill conducted on 05/27/2024. RECORD REVIEW: LPA began record review at 10:20AM. LPA reviewed 5 (five) out of 5 (five) resident files and 4 (four) staff files for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. Three (3) out of five (5) resident files were missing documents. Staff files were complete and had no missing documents. Report Continued on LIC 809-C MEDICATION REVIEW: Medications are centrally stored and locked in a cabinet in the kitchen. LPA began medication review at 11:24AM and medications for 2 (two) residents were observed. All medications were labeled and maintained in compliance with label instructions, and state and federal law INTERVIEWS: During today's visit, LPAs interviewed two (2) staff and one (1) family member of resident. Residents did not want to be interviewed. During today's visit, LPA obtained a copy of the facility's liability insurance. Pursuant to Title 22, CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Administrator was informed that failure to correct deficiencies may result in civil penalties. Exit interview conducted, report issued, and appeal rights provided.