Routine inspection·August 25, 2021

On 8/25/21 at 12:45 p.m. Licensing Program Analysts Nina Galarza and Nune Margaryan arrived at the facility to conduct an unnanounced annual visit. LPAs met with Teresita Roda and later met with administrator Gladys Pervez and stated the purpose of the visit. LPAs observed COVID informational, hand washing protocol postings outside the facility and throughout the facility. LPAs were screened for COVID symptoms and temperature was taken by staff. The facility is licensed to serve one (1) Bedridden and five (5) Non-Ambulatory residents (ages 60 and above). The facility has an approved Hospice Waiver for two residents on file. Currently, there are six (6) residents in placement. The facility is a single story home located in a residential neighborhood. LPA observed the facility to have four (4) resident bedrooms, 2 bathrooms, living room, dining room, kitchen, garage equipped with a laundry area and an indoor/outdoor activity area. Bathrooms are clean and operational with grab bars and non-skid surface mats in place. The hot water temperature measured at 114 degrees Fahrenheit and 117.2 degrees Fahrenheit. Adequate linen and personal hygiene supplies. LPAs observed 2 days worth of perishable and 7 days worth of nonperishable foods for all clients. Smoke and carbon monoxide detectors are dual/hardwired and operable. All mandated documents are posted in a prominent place. The outdoor activity area is free of visible hazards and debris. There is shaded patio areas with ample seating in the rear. The trash cans have covered lids. Staff and resident records have required documentation. All exit doors are equipped with auditory device alarms. CONTINUED 809-C The following deficiencies were observed at time of visit: R1 was prescribed Purelax powder, 1 Capful as needed, but was not listed on residents Medication Administration Record (MAR) R2 was missing Bezonate, 100 mg; 1-2 cups for cough. R3 medication was not labeled for; Acetaminophen 325 mg, Milk of Magnesia, Aspirin 81 mg, and Antacid Liquid R4 medication was not labeled; Melatonin 10 mg Deficiencies cited per California Code of Regulations. Exit interview conducted, a copy of appeal rights and report given to administrator.