Routine inspection·March 11, 2022

Licensing Program Analyst(s) (LPA) Mary Flores and Deputy Director Kevin Gains conducted an unannounced annual visit at the facility with focus on the infection control domain, food and medication review. LPA and Deputy Director met with Malou Bernardo Business Office Manager and explained the reason for the visit. Rocio Gonzalez Wellness Coordinator arrived 20 minutes later. The facility is licensed to serve 206 residents over the age of 60 years old of which 171 may be non-ambulatory, 35 bedridden, and a hospice waiver for 20 hospice residents. There are currently 12 residents on hospice. Facility cares for dementia residents and has delayed egress on exit doors. There is a water feature in the courtyard. The water feature has a fence around the entire perimeter. Facility has a fire sprinkler system throughout the facility. LPA, Deputy Director and Malou Bernardo Business Office Manager conducted a tour of the facility and observed the following: All common areas are clean and in good repair. Kitchen was observed clean, food was reviewed and sufficient for at least 2 days of perishables and 7 days of non-perishables. Freezer's temperature was observed at 10 degrees F. which is not within the required temperature of 0 degrees F. Resident's bedrooms #110,116,119, 138,245,248,252,255,259,263 were observed, all bedrooms have sufficient lighting, furniture, and bedding; room #110 - has a broken bed frame. Bathrooms were observed in each room and each has the required grab bars, bathroom #3 next to vent water damage was observed of about the size of a pen. bathroom #3, 7, 9 were missing a skid mat in the shower. Water temperature was tested in each resident's bathroom and tested between 99.1 - 109.5 degrees F. which is not within the required 105-120 degrees F. Medication and files were reviewed for resident #1,2,3,4,5,6,7,8,9,10,11, for resident #2,4,6,7,9,10 medication sheet was missing staff's initials next to dose provided for March 10th and 11th. files for staff #1,2,3,4,5,6 were reviewed. (CONTINUED ON LIC 809D) Facility is following infection control recommendations and guidelines, except for screening residents upon returning from outings. Deficiencies will be noted on LIC 809D per Title 22 Regulations Chapter 6 Division 8. Exit interview was conducted with Lori Lackey Assistant Administrator and a copy of this report, LIC 809D, Technical Advisory, and Appeal Rights were provided.