Routine inspection·October 4, 2021

Licensing Program Analysts (LPAs) Joscelyn Martinez, Gary Tan, and Yelena Avestisyan conducted an unannounced 1-Year Required Inspection at the facility today and met with Administrator Aris Vergara and explained the purpose of the visit. The facility consists of two( 2) memory care units (Willow and Evergreen) and an assisted living unit. There are currently twenty eight (28) residents residing in Willow Memory Care, twenty (20) residents residing in Evergreen Memory Care and sixty (60) residents residing in assisted living At 9:00 am, LPAs conducted record reviews of randomly selected staff and residents. At 2:40 PM, LPAs conducted a physical plant tour with the administrator to ensure that there is no health and safety hazard and facility is in compliance. The following were observed: Memory Care Units: (Willow and Evergreen Memory Care) The following were observed. There were no required COVID sings in the hallways nor walls. There were PPE stations throughout the memory care unit, there was no covered trash bin to discard the PPE upon exit. At 2:55 PM upon entrance in room 109 and 107 LPAs smelled a strong foul odor. In room 108 there was no running water in the bathroom sink, and resident's room did not have the require furnishing as well as the exit door was locked from the inside also, room 107 was observed to be locked from the inside. At 3:05 PM LPAs also tested the pull cord in room 108 and staff did not response. LPA's pulled the pull cord in room 238 and no staff responded. LPAs observed the second floor dining room flooring and tables in disrepair. (Continue on LIC 809-C) ASSISTED LIVING: at 3:25 pm, a random selection of five assisted living units on level 1 and level 2 were inspected. .LPAs observed that the door in room 105 was locked from the inside in that has bedridden fire clearance. Room 142 has a camera, empty portable oxygen tank, lamp cover was broken, exit door leading to the patio is unlocked, fire alarm is not working and the flooring is in disrepair. Pull cord was tested at 3:30 pm and no staff responded. Room 136, blinds were in disrepair, bathroom sink is clogged and no smoke alarm was installed or removed. Room 210 has no furniture and no night stand and the carpet was dirty. Room 221 blinds were broken and the resident is using full bed rails with without doctor's order. Room 242 resident is bed bound but the room in only cleared for non-ambulatory only. Random residents bathroom water temperature were checked and measured at a range of 118 degrees Fahrenheit to 164.1 degrees Fahrenheit. All grab bars were observed to be in good repair. COMMON AREAS: The fire extinguishers are located all over the facility and last inspected on 09/20/21 . The facility is equipped with fire sprinkles. Dining room not currently being used. RESIDENT RECORDS: at 9:00 am, a random selection of 11 resident files were reviewed. Files reviewed were complete with, but not limited to signed admission agreements, medical assessments and current appraisals. 5 out of 5 residents with dementia did not have a updated Physician reports. Eleven out of Eleven residents' file did not have an updated Appraisal and Needs and Service Plan. STAFF RECORDS: At 11:00 am, a random selection of 6 staff files were reviewed. Staff files reviewed had health screenings with TB results and medication training requirements. One out of six staff files did not have a Health and Screening on file. Four of six staff files does not have a current First Aid Certificate. The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22. A copy of the report and appeal rights provided.