Routine inspection (multi-day)·October 24, 2023

Licensing Program Analyst (LPA) Tena Herrera conducted the continuation of the required annual inspection. LPA arrived unannounced and met with Samantha Alex (Administrator) and explained the purpose of today’s visit. The facility is licensed to serve 6 ambulatory elderly residents ages 60 and above. The facility is a single-story home located in a residential area. A tour of the facility includes: 2 living rooms, dining area, kitchen, laundry room with pantry, 4 bedrooms (2 client bedrooms, 1 administrators’ bedroom, 1 administrators daughters bedroom), 3 bathrooms (2 client and 1 Staff bathroom), back yard with required shaded area and outdoor furnishing. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit todays visit and the initial visit and observed the following: Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting clients’ medications. Staff are still cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies. However, there was not an Infection Control Plan on file or accessible for review during initial (this is being cited on 809D). Operational Requirements: The facility has an approved fire clearance and outdoor activity area that is shaded and furnished for outdoor use. Staffing : Administrator Certificate and qualifications were not readily available during visit, this will be cited on 809D page. Personnel Records-Training : Staff has criminal record clearance, current first aid and CPR, and training. Residents Rights-Information: Residents are provided with telephone and internet at the facility. The facility does not have the required Residential Care Facility for the Elderly (RCFE) Complaint Poster this will be cited on the 809D page. Resident Records-Incident Reports: Client files are kept in a secure location and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan. (Continued on 809-C) Physical Plant & Environment Safety: Clients’ bedrooms were checked and closet/drawer space to accommodate each client comfortably was available. During initial visit LPA observed bedding to be out of regulation, during subsequent visit bedding was still out of regulation with there being blanket and mattress pad only on one bed (missing bed sheets) [administrator stated resident does not wish to have sheets on bed] and blanket with sheet on other (missing mattress pad) [administrator stated that they use the plastic covering that comes with the mattress upon purchase as a mattress pad which is not compliant with regulation] this will be cited on 809D page. The backyard is free of debris/hazards and the outdoor and passageways are free of obstruction. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available. The hot water temperature was tested in resident bathroom during initial visit and was out of range (citation was issued) during subsequent visit water temperature was measured and was out of range at 127.2 degrees F the required range is 105-120 degrees F (new citation being issued today for water temperature). During subsequent visit cleaning supplies and toxins were centrally stored and inaccessible to residents. Smoke detectors and carbon monoxide detectors are operable and in compliance. The fire extinguisher was observed and is fully charged. During initial visit it was stated that the kitchen remains locked to prevent residents from accessing medications and sharps that are stored within the kitchen, staff had indicated the only reason the kitchen was unlocked was because LPA was conducting tour, during subsequent visit LPA observed kitchen doors to be open and unlocked, LPA asked to see where sharps/knives were stored and they were stored in an unlocked cabinet as well as medication unlocked (citations will be issued on 809D). Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Health Related Service: Staff designated to administer medication has the proper training on file. Medication is properly labeled and are centrally stored in a cabinet and are in their original containers (during subsequent visit LPA observed medication cabinet to be unlocked, cited on 809D). During the initial visit, LPA reviewed 3 clients’ medication no issues were observed. Incidental Medical & Dental: Licensee assists in arranging medical and dental services to residents in care. (continued on 809-C) Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. Residents with Special Health Needs: There are currently no resident at this facility with special health needs. Per California Code of Regulations, Title 22, and California Health and Safety Code, deficiencies observed during today’s visit are documented on the 809(D). Exit interview held and a copy of the report was provided to Administrator Samantha Alex.