Routine inspection·December 6, 2021

Licensing Program Analysts (LPAs) Ashley Smith and Elsie Campos arrived at the facility unannounced to conduct a required annual visit at 9:30 a.m. When the LPAs arrived, there were two staff and three residents present. The LPAs were greeted by staff and informed them of the reason for the visit. Administrator Galina Melkonyan arrived shortly thereafter. At 10:40 a.m., the LPAs toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: The LPAs began the inspection in the kitchen/food service area. At 10:44 a.m., knives were observed a cabinet with the lock disengaged. At 10:45 a.m., the LPAs observed an accessible lighter, knife sharper, multi-purpose swiss army knife, and pizza cutter in the drawer. At 10:46 a.m., cleaning supplies were accessible in a cabinet with the lock disengaged. At 10:48 a.m., the LPAs observed the medication cabinet, with a disengaged lock. At 10:49 a.m., medications were found accessible in a kitchen drawer. At 10:51 a.m., non-perishable goods were observed to be poorly packaged. At 10:54 a.m., accessible medications were observed in the fridge. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 10:55 a.m., the hot water temperature was measured in the kitchen at 106.2 degrees Fahrenheit. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is covered and inaccessible. The facility maintained a comfortable temperature of 69 degrees. Smoke detector(s) and carbon monoxide detector were tested at 11:12 a.m. and were operational at the time of the visit. The fire extinguishers were fully charged yet were purchased 11/2019. All exits have functioning auditory devices, however they were not on during today’s visit. At 10:58 a.m., accessible medications were located in an unlocked hallway closet. At 11:08 a.m., accessible medications were observed in the dresser located in the activity room. The LPAs observed required postings in the foyer. Cameras were observed in the common spaces. The backyard has a covered outdoor area equipped with furniture for resident use. There is a side gate for resident usage and is single-latched. There are no bodies of water noted. The garage is only accessible from outside the facility and is accessible via a garage opener. The washer and dryer are in the garage. BEDROOMS: The LPAs observed the single-occupancy resident bedrooms, which were furnished appropriately with clean linens, furnishings and sufficient lighting. At 11:09 a.m., accessible medications were noted in Bedroom #4. There was a linen closet in the hallway with extra towels and linens. The LPAs reminded the Administrator that staff cannot sleep in common spaces (ie. living room). RESTROOMS: The resident restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The restrooms were sufficiently stocked with supplies and paper towels. Accessible cleaning supplies were observed in all restrooms. At 11:00 a.m., the LPAs observed that the common hallway restroom required additional lighting. At 11:01 a.m., the hot water temperature measured in the hallway restroom at 110.3 degrees Fahrenheit. RECORDS: Personnel records review began at 11:30 a.m. and records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. The following was noted: one out of three staff (S2) needs an updated tuberculosis test. Two out of three staff (S1, S2), need a completed Criminal Record Statement. The LPAs were unable to verify the required forty (40) hours of training for Staff #3 (S3), nor the twenty (20) hours of annual training for S2. The Administrator’s Certificate expires 12/21/2022. Resident records review began at 12:10 p.m.; resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. The appraisals for Resident #1 (R1) and Resident #2 (R2) were not signed by the responsible party. The following documents for R2 were either blank or incomplete: admission’s agreement, consent forms, personal rights form. Resident #3 (R3) is on hospice, yet there was no hospice care plan on file. MEDICATIONS: Medications review began at 4:00 p.m.; medications are centrally stored and locked in a cabinet in the living room; medications are labeled and checked for expiration dates. Medications are not properly documented on the centrally stored medications and destruction record. The Administrator is preparing medications for residents more than twenty-four hours in advance and the LPAs were unable to successfully complete a medication audit. INFECTION CONTROL: Upon entry, the facility has a central entry point for symptom screening, temperature checks, and a sanitation station. 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 facility has up-to-date vaccination records for all staff and residents. The facility’s policies and procedures as it pertains to infection control are adequate. The Administrator was reminded of the policy for mask wearing and noted that staff needed to wear masks at all times. 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. Exit interview conducted. A copy of the report and appeal rights were provided.