Routine inspection·June 19, 2023

Licensing Program Analysts (LPA) Christine Wong conducted the required annual inspection. LPA arrived unannounced and met with caregiver Maryanne Vergara and Joel Basilio assisted with the visit. The purpose for the visit was explained. The facility is licensed for residents ages 60 and over. The fire clearance is licensed to serve elderly residents age 60 and above. The fire clearance approved for two (2) ambulatory and four (4) non-ambulatory residents age 60 and above. Approved to accept or retain resident one (1) on hospice. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: 1.infection Control : The facility staff are using appropriate hand hygiene and wearing gloves while assisting residents. Staff are cleaning and disinfecting once a day and more often for high touched surfaces area. Facility has sufficient PPE supplies and has an Infection Control Plan. 2. Operational Requirement: The facility has a dementia care plan to accept or retain residents with dementia. There is currently one resident is on hospice and bedridden which is under the fire clearance requirement. The facility has the sufficient amount for liability insurance covering injury to residents and guests. 3. Physical Plant and Environmental Safety: The facility is a single story house and located in residential neighborhood area. The facility includes family room, dining room, kitchen, living room, five residents bedrooms, one live in staff bedroom, three bathrooms, laundry room, staff office and an isle. All the passageway and drive way and patio are free of obstruction. The facility has a pool in the backyard but they were covered by the fence and they are inaccessible to residents. Bedroom#1 - #4 has one bed, one night stand, one drawer, one chair, required beddings and sufficient lighting and closet space. Bedroom#5 has two beds, two drawers, two night stands, two chairs, required beddings and sufficient lighting and closet space. The bathrooms are clean, sanitary and in an workable condition. All the bathrooms also have grab bar and non-skid mat. The hot water water temperature in bathroom#1 and #2 are tested between 113.1 and 118.5 degrees F and they are within the Title 22 regulation. All the kitchen appliances are working properly. All the sharp knives and utensils are stored and locked in the kitchen drawer next to the sink. All the cleaning supplies and chemicals are stored and locked in the cabinet in the laundry room. The facility has ample supply of personal hygiene products and stored in the bathroom#1, LPA inspected the carbon monoxide detectors and smoke detectors and they are interconnected and they are operable. 4. Staffing: There is sufficient staffing at the facility. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Staff all have updated First Aid and CPR certificate except the administrator. 5. Personnel Records/Staff Training: All staff files are maintained in the facility except the administrator file. The administrator is Terry McGee but due to administrator files was not maintained in the facility and LPA did not know when the administrator certificate will be expired. 6. Resident's Record/Incident Reports: All residents files are stored and maintained in the facility in the medication cabinet. The resident files do not have a complete and current record. Resident#1 is missing Resident appraisal, admission agreement. Resident#2 is missing pre-appraisal, resident appraisal, and updated physician report. Resident#3 is missing physician report and resident appraisal. Resident#4 is missing resident appraisal and physician report. Resident#5 is missing admission agreement, physician report and resident appraisal. 7. Resident's Right and Information: The facility has all the posted include resident's personal right and complaint poster..etc and its located on the wall near the entrance. The facility also has internet service device for residents to use. 8. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. 9. Food Services: There are sufficient food supplies of 2-days perishable and a week of non-perishable items. The food are properly stored in the refrigerator. 10. Incidental Medical and Dental : All residents medication are centrally stored and locked in the hallway medication cabinet. LPA inspected all resident medication and they all seemed accurate and updated. 11. Disaster Preparedness: The facility does not have an updated emergency disaster plan but facility does have two alternative shelter location and the facility does not have any record of the last fire or earthquake/disaster drill. 12. Residents with Special Health Needs: The facility accepts and retains residents with dementia and/or hospice. The staff received training on appropriately caring for residents with dementia and those on hospice. On today's visit: Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8 Exit interview was conducted, Appeals Rights discussed and a copy of the report was given to the caregiver Joel Basilio