Routine inspection·October 28, 2022

Licensing Program Analyst (LPA) Mora conducted an unannounced annual visit at the facility with focus on the infection control domain, medication and food review. LPA Mora met Linda Renard (Administrator) and explained the reason for the visit. The facility is licensed to serve six non-ambulatory residents ages 60 and over and may retain up to three hospice residents. The facility is not operating within the scope of its license. There is a 7 th resident sharing a bedroom with another resident. This resident will be referred as Resident 7 (R7). Interviews with administrator and staff revealed that R7 is non-ambulatory (uses a walker), has medication locked and is assisted with administering medication, is unable to leave the facility unassisted, has possible dementia, and goes on outings with the rest of the residents and facility staff. R7 is the mother of the administrator’s best friend and administrator considers her a family member and not a resident. The facility is located in a residential area. A tour of the single-story facility included: 4 resident bedrooms, 2 resident bathrooms, living room, kitchen, dining area, front yard, backyard, and attached garage. LPA and Linda toured the facility and the following was observed: sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. Auditory devices were seen on all exit doors which are required for dementia residents and were operating at the time of the visit. The water temperature was tested in the residents’ bathrooms and measured at 119.7 and 115.5 degrees F which is within the required 105 - 120 degrees F. The bathrooms are clean and have the required grab bars in the shower and near the toilet for non-ambulatory residents. The shower has non-skid materials. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have enough closet space. Resident beds have the required linen and the linen is in good condition. There is extra clean linen and towels in one of the resident’s bathroom cabinet. Smoke detectors combined with carbon monoxide were observed in each room and throughout the facility and are properly operating. A fire extinguisher was observed in the kitchen which is fully charged. Kitchen appliances are clean and were operating at the time of the visit. Knives are kept locked in a kitchen cabinet. Cleaning chemicals are kept locked in the garage. (CONTINUED TO LIC 809C) First Aid kit was fully stocked with current manual and it is kept locked in the medication cabinet. The front and backyard are well maintained. There is a shaded seating area for the residents located in the backyard. There are no bodies of water. Passageways and exits are free of obstruction. Residents medication are centrally stored in a locked kitchen cabinet. Residents and staff files are centrally stored in a locked kitchen cabinet. LPA reviewed medication for 7 of the residents and observed that medications are given as prescribed. LPA reviewed files for 6 residents and 7 staff, observed no deficiencies. R7 does not have a file due to the administrator stating she is not considered a resident. LPA observed administrator certificate for Linda Renard - 60268844740 with an expiration date of 05/02/2023. Facility is following COVID 19 recommendations regarding screening visitors, staff, and residents. Signs are posted throughout the facility, and hand-washing signs were observed in bathroom. Sufficient hand soap, hand sanitizer, and paper towels were observed. Supply of 30-day Personal Protective Equipment (PPE) was observed in the garage. Per California Code of Regulations, Title 22, and California Health and Safety Code, there was one deficiency observed and a civil penalty was issued during the visit (refer to LIC 809D & LIC421IM). Exit interview held and a copy of the report and appeal rights were provided.