Routine inspection·August 24, 2023

Licensing Program Analysts (LPAs) Galarza Nune Margaryan conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to Administrator Ana Duenas. There are currently 4 elderly residents 60 years and older residing in the facility. One (1) resident is receiving hospice care, one (1) resident receives home health, one (1) resident has Dementia, and one (1) resident is bedridden. The inspection was completed using the CARE tools. Twelve (12) CARE tools domains were reviewed. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. Visitors are no longer screened for COVID-19 or required to sign in. The facility submitted a COVID-19 Mitigation Plan, but an Infection Control Plan has not been submitted. Operational Requirements: A current Plan of Operation was reviewed. The facility has a Dementia Waiver in place. A Hospice Waiver for 3 is approved. A fire clearance for 5 non-ambulatory adults 60 and over; of which one (1) may be bedridden in room 4 only. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is expired. Licensee/Administrator has not renewed the policy in several years. A surety bond is not applicable. Facility does not handle resident's money. Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood consisting of 4 resident bedrooms (2 shared and 1 private), 2 bathrooms, living room, dining room, kitchen, outdoor covered patio area, and 2 car attached garage with laundry area. Resident room # 3 is presently being used as a live-in staff room for staff (S2), and staff (S3) sleeps in the living at night. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Kitchen drawers containing knives/sharp objects were unlocked, and scissors were observed unlocked in the living room and kitchen. Citation was issued. The facility has three (3) fully charged fire extinguisher and fire sprinklers. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. Water temperature ranged between 101.6 - 109.9 degrees Fahrenheit. Staffing: A total of 2 caregiver staff provide care and supervision to the clients. Personnel Records/Staff Training: Administrator certificate expired 7/26/2021. Licensee/Administrator submitted proof of training to certification unit and is awaiting receipt of current certificate. Personnel files were reviewed. They were missing current staff training and staff (S1 & S2) did not have 1st Aid/CPR training on file. The last documented training for staff (S2 & S3) was in 2018. Resident Records/Incident Reports: A total of two (2) resident files were reviewed. Residents (R1 & R3) did not have any files. Administrator stated residents have not been appraised and required documents have not been obtained from resident responsible parties. Dementia resident (R2's) Physician Report is not updated. Licensee/Administrator shall ensure residents are appraised and there is record of all required documents as soon as they move in. Missing documents are admission agreements, Physician's Reports, Appraisals, TB clearance, COVID-19 vaccine cards, Functional Capability Assessment, and emergency information. RCFE complaint poster and Personal rights were observed posted in the facility entrance area. ***narrative continues next page*** Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Minimal indoor and outdoor activities are performed. The facility does not have a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. However, expired food cans and damaged food cans were observed in the kitchen pantry. Citation was issued. Physician orders for modified diets are in place. Incident Medical and Dental: 30-day supply of resident medications were observed. No Centrally Stored Records for medications are kept. Citation was issued. Medication error was observed in resident (R2's) bubble pack. Controlled subtance Hydrocodone 325 mg is supposed to be administered 3 times a day, but it is given as a PRN . Citation was issued. Medical and dental transportation is provided by family members and Administrator. Disaster Preparedness: Emergency and Disaster Plan LIC 610E is in place and was posted today. The last emergency disaster drill was conducted in late 2019. Citation was issued. Residents with Special Health Needs: One (1) resident receives hospice care and one (1) resident received home health services. Hospice Care Plan was reviewed. Postural supports are used by one resident. No physician orders are on file. Full and half bed rails for mobility assistance were observed in resident beds. No residents have prohibited health conditions. Per California Code of Regulations, Title 22, deficiencies were cited. Exit interview was conducted with Administrator Ana Duenas. A copy of the report and appeal rights were issued.