Routine inspection·November 30, 2023

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to caregiver staff Virginia Villacorte. Administrator Helen Torres arrived shortly after. There are currently 4 elderly residents 60 years and older residing in the facility. Twelve 12 (CARE) tool domains were utilized during the inspection. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed Staff are no longer wearing masks or screening visitors. A visitor sign-in station is still in place. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. Operational Requirements: A current Plan of Operation was reviewed. The facility has a Dementia Waiver in place. A Hospice Waiver for 6 is approved. Facility has a fire clearance for 6 non-ambulatory adults 60 and over. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place and expires 6/2/2024. A surety bond is not applicable. Facility does not handle resident's money. ***Narrative continues next page.**** Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood that is licensed for six (6) non- ambulatory residents. The facility consists of (3) resident bedrooms, (1) staff room, (2) bathrooms, living room, dining room, kitchen, and attached garage. The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area for the residents located in the backyard. Exit doors are free of any obstruction. Kitchen drawers containing knives/sharp objects were unlocked. Citation was issued. The facility has one (1) fully charged fire extinguisher, fire pull alarm, and fire sprinklers. Water temperature readings did not measure within the required 105 - 120 degrees Fahrenheit. Water temperature ranged between 119.3 DF - 126.7 DF. Citation was issued. Staffing: A total of 5 caregiver staff provide care and supervision to the clients. Personnel Records/Staff Training: Administrator certificates expires 4/23/2024. Personnel files/training were reviewed. Proof of staff training, health clearance, criminal background clearance and 1st Aid/CPR training was observed in staff files. Resident Records/Incident Reports: A total of four (4) resident files were reviewed. Files contained admission agreements, Physician's Reports, Appraisals, TB clearance, COVID-19 vaccine cards, Functional Capability Assessment, and emergency information. RCFE complaint poster and Personal rights were observed posted. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Minimal activities are in place and the facility does not have a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Physician orders for modified diets are in place. Sanitation practices and kitchen cleanliness was observed. Incident Medical and Dental: Four (4) centrally stored resident medications/30-day supply of medications were reviewed. Medication errors were observed. In addition, unlocked resident and staff medications were observed in a kitchen cabinet. Citation was issued. Medical and dental transportation is provided by family members and 3rd party transportation services. Disaster Preparedness: Emergency and Disaster Plan LIC 610D was posted, but the revised required form has not been developed. The last emergency disaster drill was conducted on 10/5/2023. Residents with Special Health Needs: No residents are receiving home health services. One (1) resident is enrolled in palliative care. No postural support physician orders are on file. Full bed rails for mobility assistance were observed in resident beds, but residents are not enrolled in hospice. Citation was issued. Individual Service Plans and Appraisals were not observed in resident files. No residents have prohibited health conditions. Per California Code of Regulations, Title 22, deficiencies were cited. Exit interview was conducted with Administrator Helen Torres. A copy of the report and appeal rights were issued.