Routine inspection·July 16, 2024

Licensing Program Analyst (LPA) Galarza conducted an unannounced annual inspection visit. The purpose of the visit was explained to Administrator Ana Duenas. The facility serves elderly residents ages 60 and older. A hospice and Dementia waiver is in place. It consists of 4 resident rooms, 2 bathrooms, dining room/ living room, outdoor patio area, and attached garage. The inspection was completed using the CARE tools. Twelve (12) CARE tools domains were reviewed. The following were observed/inspected: Infection Control: The Infection Control Plan was reviewed. The facility has a supply of Personal Protective Equipment (PPEs). Operational Requirements: A hospice waiver for 3 residents has been approved. A fire clearance for 5 non-ambulatory adults 60 and over; of which one (1) may be bedridden in room 4 only. Facility does not handle resident P & I monies. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current with an expiration date of 8/26/2024. Physical Plant/Environment Safety: 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. Cleaning supplies and toxic substances are inaccessible to residents. The facility has fully charged fire extinguishers. Water temperature readings did measured within the required 105 - 120 degrees Fahrenheit. Facility has a fire pull-alarm. Licensee has not kept Fire/Emergency Disaster drill logs in years. Staffing: A total of 3 staff members provide care and supervision to the clients. Personnel Records/Staff Training: Administrator certificate expires 7/26/2025. Staff have criminal background clearance and training. Three (3) staff files were reviewed. Proof of staff training, health clearance, and 1st Aid/CPR training. Administrator's 1st Aid/CPR training was not on file. Resident Records/Incident Reports: A total of six (6) resident files were reviewed. They contained admission agreements, Physician's Reports, Appraisals, TB clearance, Physician's Orders, medical consent. No centrally stored medication records or medication administration records are in place. RCFE complaint poster and Personal rights were observed posted. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. 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. No residents are on modified diets. Incident Medical and Dental: Six (6) centrally stored resident medications were reviewed; containing a 30-day supply of medications. Medical and dental transportation is provided by family. Disaster Preparedness: Emergency and Disaster Plan LIC 610E was reviewed. Facility has a First Aid Kit and Manual. Residents with Special Health Needs: Three (3) r esidents are receiving hospice services and zero (0) resident receive home health services. Two (2) residents have a Dementia diagnosis. Full bed rails for mobility assistance were observed in hospice resident's rooms. No residents have prohibited health conditions. Per California Code of Regulations, Title 22, deficiencies were cited. Exit interview was conducted with Licensee Ana Duenas. A copy of the report and appeal rights was issued.