Routine inspection·May 12, 2022

At approximately 1:55 p.m. on 05/12/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with staff #1 (S1) and disclosed the reason for the visit. At approximately 2:10 p.m. S1 called Administrator (S2). LPA spoke with S2 and disclosed the reason for the visit. S2 stated that due to an emergency, they could not come to the facility today. LPA informed S2 that an administrator or designated representative must be available at the facility at all times. S2 requested the inspection be rescheduled for Monday. LPA stated the inspection must be conducted today. LPA asked if S1 could sign in S2’s absence. S2 refused. LPA and S1 toured the facility inside and out. The facility was last visited on 05/24/2019 for a an annual inspection. It is a single story building with 5 bedrooms, 3 bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for 6 nonambulatory residents, of which 1 may be bedridden. The facility serves a resident with cognitive impairment. Approved hospice waivers for 2. The facility uses surveillance cameras inside and out. Entry: LPA observed a maintained front yard. Once inside, LPA observed postings for confidential complaints, resident councils, resident rights, COVID policies, facility license, and two Administrator certificates. The certificates expired on 05/09/2020 and 06/21/2020. At 3:03 p.m. LPA conducted a record review of current and pending administrator certificates at https://cdss.ca.gov/inforesources/community-care/administrator-certification/administrator-information/active-certificates . LPA did not see either administrator listed. LPA called a secondary Administrator (S3) at 4:54 p.m. S3 stated all documents were submitted one year ago. LPA will confirm proof of documentation on 05/16/2022. Screening: LPA was not screened for infectious disease upon entry. The facility did not have a screening station. S1 and staff #4 (S4) were observed without a mask for the duration of the inspection. The facility does not have a screening station. Bedrooms: The facility has 5 bedrooms. 4 are private and 1 is shared. All bedrooms contained a chair, nightstand, storage, and bed with adequate bedding. All furnishings were clean and in good condition. Bedroom #3 contained a resident using oxygen. A sign indicating oxygen is in use was posted on the bedroom door. At approximately 2:30 p.m. LPA observed 5 medication bottles on the bedside table in Bedroom #5. S1 explained they were there for the resident’s preference. S1 also explained that some pills were Russian. LPA observed a clear vial with yellow pills inside and non-English writing on the label. LPA explained that all medication must be locked. Bathrooms: The facility has 3 bathrooms. All bathrooms contained liquid soap, paper towels, handwashing instruction sign, trash cans, devices with grab bars near the toilet and shower, and a non-skid mat in the showers. At approximately 2:20 p.m. LPA observed 4 creams in the Bathroom #2. Staff explained the creams were for itchiness. At 2:51 p.m. LPA measured the water temperature in Bathroom #2 to be 106.6 degrees Fahrenheit. Kitchen: LPA observed an adequate supply of perishable and non-perishable food. All surfaces were clean. Sharp objects were locked under the counter. Laundry: The laundry room was locked with an “Employees Only” sign. Bleach and detergent were sitting next to a washer and dryer in good condition. The garage was accessible through the laundry room and was free of hazards. Common Areas: Walls, floors, ceilings, windows, and screens were clean and in good repair. Medication was locked near the kitchen and dining room. At 2:21 p.m. LPA measured the indoor temperature to be 73 degrees Fahrenheit. Safety: All emergency exit paths were free from obstructions. Exterior exit gates on the east and west side were locked. At approximately 2:35 p.m. LPA asked staff why the exit gates were locked. Staff stated R1 likes to wander. S1 stated they do not have the key to unlock the gates. Emergency Disaster Plan posted at the entrance. LPA observed a smoke detector near the ceiling at the main entrance. LPA will test smoke and carbon monoxide detectors during the Annual – Continuation visit. Outdoor areas: LPA observed a covered patio with furniture and workout equipment. A shed at the rear of the facility was locked. At 2:44 p.m. LPA observed Resident #1 (R1) ask S1 to go outside. S1 replied, “You’re not going outside today because you were outside today earlier”. S1 then sat with R1 and watched television in the living room. At 2:59 p.m. staff #4 (S4) entered the facility at the main entrance. S4 was not wearing a mask and was not screened for infectious disease. At 3:37 p.m. R1 walked out of a side door. S1 said to R1, “No, close door. Please, I don’t have key. Not today" S4 and S1 followed R1 outside. S4 explained to LPA that R1 is agitated. R1 was overheard cursing at S4. At approximately 4:19 p.m. 3 family members of a resident visited the facility without being screened or wearing masks. One family member stated, "We tried to call, but no one ever answers the phone". Administrator refused to sign all documents. During today's inspection, the facility was in not compliance with Title 22 regulations. Citations issued on LIC 809-D page. Exit interview conducted. Copy of report and appeal rights provided.