Routine inspection·October 24, 2023

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual inspection. The LPA met with staff Heber Alcazar and explained the reason for the visit. The Administrator Jefferson Reyes arrived shortly thereafter. The LPA and the staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature of 70 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The two fire extinguishers were fully charged and were last purchased on 10/11/2023. The LPA observed required postings throughout the common space. Linen closet had sufficient linens for all residents. KITCHEN: The kitchen area was observed to be clean. Knives and cleaning supplies are stored inaccessible to residents. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. The hot water temperature measured within the required limits. BEDROOMS: There are five bedrooms designated for residents' use. Bedrooms are private. Bedrooms were clean, properly furnished and had sufficient lighting. Appropriate bedding and linens were observed. RESTROOMS: The three residents’ restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The staff’s restroom was clean and sanitary. The restrooms were sufficiently stocked with soap and paper towels. The hot water temperature measured within the required limits. Continues on LIC 809C...page 2. OUTDOOR AREA: Entry/exits were free of obstruction. The outdoor area has furniture appropriate for outdoor use. The garage is a separate structure from the home and is used for storage/office. The laundry area is just off the kitchen, detergents are stored in a locked shelf in the laundry area. Washer and dryer appeared to be functional. RECORDS: Records review began at 12:15 p.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 2:15p.m. Medications are centrally stored and locked in a kitchen cabinet; medications are labeled and were checked for expiration dates. During the medication review the LPA and the licensee observed that the medications were not properly documented on the centrally stored medications and destruction record. The following errors were observed during the medication review. Five (5) out five (5) residents’ Centrally Stored Medication and Destruction Record forms were incorrectly filled out. The forms had incorrect dates for when prescriptions were filled, prescriptions started, missing or incorrect quantity of pills. At least one medication (Escitalopram-5mg/90pills/date filled 2/11/2023) was not given to resident as prescribed by physician. The pill count in the medication bottle was 97 pills. INFECTION CONTROL : The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. The LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster Deficiencies were cited at this time. Exit interview conducted. A copy of the report was issued.