Routine inspection·October 17, 2024

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 09:22AM. LPA met with Caregiver Norma Gregorio and reason for the visit was explained. Entrance interview conducted. Staff contacted Administrator Elaine Bote who arrived at 10:25AM. Beginning at 09:24AM, the LPA, along with the caregiver toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: BEDROOMS: There are six (6) single-occupancy resident bedrooms. At 09:27AM, LPA observed Bedroom #1 with two (2) out of four (4) light bulbs not working. Staff replaced the light bulbs during the visit. All client bedrooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. BATHROOMS: There are three (3) bathrooms, two (2) are in the hallway and one (1) is attached to Bedroom #3. All bathrooms were supplied with appropriate soap and paper towels. Between 09:30AM – 09:42AM, water temperatures were measured in bathrooms and measured within 128.2 degrees F – 138.7 degrees F, which is outside of the required range of 105 degrees F – 120 degrees F. Staff lowered water heater. At 12:01PM, LPA measured water temperature in bathroom #1 which measured at 135.0 degrees F. Administrator installed warning signs to label and properly identify hot water until the water heater can be repaired. KITCHEN: At 10AM, LPA inspected the kitchen/food service area. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and non-perishable food. At 10:09AM, LPA observed a spoiled cucumber, vegetable produce stored without bags or containers, a dented can of tomatoes, and opened and unrefrigerated jars of relish and jam. Staff discarded all items immediately and stored vegetable produce in bags. Knives, sharps, cleaning supplies, and disinfectants are stored inaccessible in a locked cabinet. Report Continued on LIC 809-C COMMON AREAS: These include the living room and dining area. Common areas were appropriately furnished and in good condition. Carbon monoxide detector was tested at 10:58AM and was operable. Smoke detectors were tested at 10:59AM. LPA observed the smoke detector in the living room not working. Staff attempted to fix the detector during the visit. Staff purchased and installed a new smoke detector which was tested at 03:09PM and was operable. LPA observed two (2) fire doors, one (1) to the hallway leading to resident bedrooms and the other one (1) to bedroom #6. Fire doors were not functioning properly as they had a door stopper by use of a rubber band on the handle which prevented the doors from closing when smoke detectors were tested. Administrator purchased a fire door holder that keeps the doors open during the day and is kept closed at night. Two (2) fire extinguishers were observed on a wall by the laundry room and in the kitchen area which were fully charged and last purchased 05/06/2024. Required posters were displayed throughout the common areas. OUTDOOR AREA: The backyard has patio furniture and a covered area. No obstructions observed in the passageways. No bodies of water were observed. MEDICATIONS: Medications review began at 10:17AM; medications are centrally stored and kept inaccessible in a locked kitchen cabinet. LPA reviewed medications for three (3) residents. LPA observed three (3) medications which were not logged on the centrally stored medication and destruction record. Staff immediately logged the medications. RECORD REVIEW: LPA began record review at 11:06AM. LPA reviewed five (5) out of six (6) client files for documents including, but not limited to: appraisals, medical records, admissions agreement, and consent forms. One (1) out of five (5) residents had an initialed but not signed and dated Admissions Agreement. Resident reviewed and signed the Admission Agreement at the time of the visit. LPA reviewed three (3) personnel files for documents including, but not limited to: personnel record (LIC 501), health assessments/screening (LIC 503), criminal record clearances (LIC 508), active first aid/CPR training, and appropriate training. LPA observed two (2) out of three (3) staff to have CPR but no First Aid training. First aid training was completed during the time of the visit. Report Continued on LIC 809-C INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices. The facility’s policies and procedures as it pertains to infection control are adequate. LPA was unable to review the emergency disaster plan and emergency disaster drills as the requested files were not kept on site. INTERVIEWS: During today’s visit, LPA interviewed three (3) residents and three (3) staff. The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Civil penalty was issued in the amount of $500. Administrator was informed that failure to correct deficiencies may result in additional civil penalties. Exit interview conducted. The report was reviewed, and a copy of the appeal rights and report were provided.