Routine inspection (multi-day)·June 21, 2024

Licensing Program Analyst, (LPA) Raymond Comer, made an unannounced site visit to this facility as a continuation of the Required 1 Year Annual Inspection conducted on 06/20/2024. LPA met with Administrator, Alexcis Peralta, and the purpose of visit was disclosed. The following remaining inspection domains were observed, reviewed and inspected : Fire Safety: Fire Detection/Protection system is present in the facility. LPA observed multiple smoke and carbon monoxide alarms installed, hardwired, and interconnected. Fire system back up and tests are completed and documented on a biannual basis. Fire Alarm System was tested and working properly. Fire drill last conducted 5/30/2024 . Fire extinguishers were observed on all floors of the Facility. All extinguishers were last serviced on 4/11/2024. Roof access is inaccessible to residents. Evacuation routes are clearly labelled and posted throughout the facility. However, LPA observed there are no evacuation chairs in the stairwells of the facility Kitchen: At 11:30 AM LPA observed kitchen to be clean, with an adequate supply of perishable and non-perishable foods located in the refrigerator, freezer, and pantry. LPA observed a variety of fresh fruits, vegetables, meats, dry cereals, and desserts. Foods are properly labeled and stored. Knives and sharps are stored in a designated area of the kitchen. Kitchen is secured and inaccessible to residents. Medications : Located on the second floor, medication room is secured. locked, and inaccessible to residents. Medications are listed on a centrally stored medication and destruction record log. First Aid kits are complete. Laundry : Room is located on sub-floor level. Laundry room, soaps, and other cleaning agents are stored and inaccessible to residents . Linen storage observed to have adequate supply of linen and towels. [Continued on LIC 809C] Commons: LPA observed upstairs and downstairs hallways, activity room, and dining room, finding them clean and furnishings to be in good condition . No obstructions, nor tripping hazards observed. Bedrooms: At 12:15 PM, LPA observed random bedrooms as clean with sufficient lighting, bed linens, at least one chair, nightstand, closet space, and dresser. Signaling system was tested and is working properly. Staff responded to activated signal within three minutes. Bathrooms: LPA observed bathrooms to be clean and sanitary, with required safety fixtures. (grab bars, anti-slip floor stripping) Hot water temperature measured at 118.°F. , within the required range. While inspecting bedrooms #204 #210, #103, and #107, LPA observed multiple deficiencies, such as unstocked paper towel supplies, cracked bathroom glass mirrors, burned out bathroom light bulbs, and loose screws on door handles. Outdoor: Courtyard observed to have a shaded patio area, with a table, and sufficient seating for residents. Outdoor furniture observed to be in fair condition. Multiple sheds in the outdoor area contain tools, supplies, and PPE. All outdoor sheds were observed as locked and inaccessible to Residents. All trash cans were covered. There are no bodies of water in the facility. Resident records: LPA observed records stored in a locked and secured records room on the first floor, inaccessible to residents. Resident files were reviewed for current IPP and/or Needs and Services plans, physician report, and admission agreements. Resident records appeared to be complete and current. Staff records: LPA observed records stored in a locked and secured records room on the first floor, inaccessible to residents. Criminal record clearances were present, and Staff are associated to this facility. Staff records appear to be complete and current. Per the CCR, Title 22, Division 6, Chapter 8 the following deficiencies were observed and cited: (Refer to the following pages LIC 809-D for list of deficiencies) Exit Interview conducted, report given, and Appeal Rights discussed with Administrator, Alexcis Peralta.