Routine inspection·September 19, 2023

Licensing Program Analyst (LPA) Alberto Lopez conducted the required annual inspection. LPA arrived unannounced and met with Business Manager Brenda Chacon who assisted with the inspection today. Executive Director Peter Bonilla also assisted with the inspection. The facility is licensed for 98 residents ages 60 and over. The fire clearance is approved for 98 non- ambulatory residents of which 15 can be . There is a hospice waiver approved for 10 residents. Currently there are 64 residents at the facility. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents with medications. Disposals of trash are done immediately after changing a resident. Staff are still cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan posted by the entrance. Operational Requirements: A current Plan of Operation was reviewed. Infection Control Plan was reviewed but not updated. The facility has a Dementia waiver in place. Liability Insurance policy in the amount of $1,000,000.00 each occurrence and #3,000,000.00 in the total annual aggregate is valid and will expire on 12/05/2023. Surety Bond is valid and in place. The last fire Drill was conducted on 08/19/2023. Care and supervision to meet the residents needs was observed. Special equipment and supplies to meet the persons with special needs were observed. Physical Plant & Environment Safety: The facility is a single-story building. Common areas, including the living room, activity room and dining room, all appeared clean and were properly furnished. The kitchen appeared clean and the appliances and fixtures functional. Entry/exits were free of obstruction. The medications were locked in the medication room. The following random resident rooms were inspected: #26, 16, 57, 54, #47, $3 and the water temperature measured between 115.7 – 118.7 degrees F which is within range of 105 – 120 degrees F. Resident Records-Incident Reports: Resident files are maintained at the facility and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan. Resident Rights-Information: The Complaint poster and Residents personal rights are posted by the main entry. Visiting hours were posted during visit. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. Food Service: The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. The food is properly stored in the refrigerator (clean, labeled and well maintained). Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents. Incidental Medical & Dental: The medications are centrally stored and in their original containers. During the visit today, LPA reviewed 6 residents' medication files and observed some PRN to not have labels attached to bottles. Disaster Preparedness: The facility has an Emergency Disaster and Mass Casualty Plan containing emergency evacuation, storage and preservation of medications, The facility conducts emergency drill on a quarterly basis for all staff and residents. Residents with Special Health Needs : No residents are receiving home health services. No resident receives hospice care. No residents have prohibited health conditions. Deficiency sited (See 809D) and technical advisory was also provided. An exit interview was held. A copy of this report, LIC809D, technical advisory note, and appeal rights were given to Staff Brenda Chacon