Routine inspection·August 5, 2024

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 10:22 AM. LPA was greeted by Facility staff who contacted the facility administrator Mariana Romano. Facility administrator arrived to the facility at approximately 10:28 AM Entrance interview conducted. Beginning at 10:28 AM, the LPA, along with facility administrator 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: COMMON AREAS : This includes the living room and dining room areas. LPA observed common area to be clean and properly furnished at the time of the visit. A camera was observed in the Living room. The LPA observed the fire extinguisher to be fully charged and serviced on 03/08/2024. At 10:30 a.m. LPA observed an unlocked cabinet that contained a prescription Ipratropium bromide and albuterol sulfate inhaler box. Smoke detectors and carbon monoxide detectors were tested at 01:01 p.m. and were functional at the time of the visit. KITCHEN : The LPA observed the kitchen area to be clean. Kitchen appliances were in operable condition. The facility has a sufficient supply of seven (7) days perishable and two (2) days non-perishable food and emergency water. The LPA observed one designated drawer where knives and sharps are stored locked and inaccessible to residents. At 10:45 a.m. LPA observed expired condiments located in the refrigerator. BATHROOMS : There are two (2) bathrooms for resident use. Bathrooms were observed to be equipped with nonskid surfaces and contain nonskid mats. Grab bars were observed next to all toilets and in all showers and all were properly secured. The water temperature was measured between 105.4 and 106.7 degrees Fahrenheit, which is in compliance with regulation. Report Continued on LIC 809-C Continued from LIC 809-C BEDROOMS : There are four (4) bedrooms in the facility; all four (4) are designated for resident use. One (1) staff room is designated as an ADU attached to the property that has a different address from the facility. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. OUTDOOR SPACE: The backyard has sufficient patio furniture including shaded tables and chairs for resident use. An outdoor pool was observed to be appropriately screened. One outdoor shed was observed to contain pool care equipment. Facility has two exit gates, LPA observed clear passageways for emergency exit use. RECORD REVIEW: Staff and resident records were reviewed 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. Resident 1’s (R1) file identified them as a bedridden patient. R1 currently resides in a room that is not approved in the facility’s fire clearance for bedridden residents. Staff 1’s (S1) file contained a positive TB test. No chest x-ray was present at the time of the file review. MEDICATION REVIEW: Medications for 2 (two) of four (4) residents were observed. All medications reviewed were documented properly on their centrally stored medication and destruction record sheet. PRN medication administration was not logged at the time of medication review. 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. Last emergency disaster drill was conducted 06/01/2024. The facility’s emergency disaster plan is up to date and adequate. INTERVIEWS: LPA interviewed two (2) staff and two (2) residents. One resident stated that the food is sometimes cold. One resident stated that they enjoy the amount of activities offered. All residents stated that staff treat them well and are attentive to their needs. Both staff were knowledgeable on resident rights, the different forms of abuse, and their roles and responsibilities. Report Continued on LIC 809-C Continued from LIC 809-C During today’s visit LPA obtained a copy of the facility’s updated LIC500 and liability insurance. The following deficiencies were observed (See LIC 809-Ds) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Licensee was advised that failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.