Routine inspection·January 30, 2024

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual inspection at 10:00 a.m. LPA Urena was greeted by staff. The Administrator Mariana Romano, arrived shortly thereafter and was explained the reason for the visit. At 10:30 a.m., the LPA and Administrator 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. 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 screened and inaccessible. The facility maintained a comfortable temperature of 74 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The two (2) fire extinguishers were fully charged and were last serviced 04/27/2023. The LPA observed required postings throughout the common space. KITCHEN: Kitchen appliances were found to be in operable condition. The emergency non-perishable food for six residents and two staff was found to be sufficient. The fresh food supply was found to be appropriate for the six residents currently residing at the facility. Kitchen knives are stored and locked in a kitchen drawer. The two (2) fire extinguishers were fully charged and were last serviced 04/27/2023. BEDROOMS: There are six (6) residents’ bedrooms currently occupied as single occupancy. Bedrooms were supplied with sufficient bedding and linens, and there were no visible hazards. Lighting and room temperature were found to be appropriate. There was a linen closet in the hallway with extra towels and linens. There at total of seven (7) bedrooms. One bedroom is designated for staff. Staff’s bedroom door was locked at the time of the visit. See LIC 809C... BATHROOMS: There are six (6) bathrooms. Each bedroom has a bathroom. The bathrooms were found to have hand washing signs, personal grooming supplies, and paper towels. The hot water temperature measured within the regulation limits. OUTDOOR AREA: The property is fenced. The LPA and Administrator observed a large water fountain in the front courtyard area with running water, however the water fountain is filled with stones so that the water is leveled with the stones in the fountain. There is furniture appropriate for outdoor use, and shade available for residents’ use. RECORDS: Records review began at 1:00 p.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. Two out of six residents’ files were missing/or were incomplete required forms: Admission Agreement, Physician’s Report, Personal Rights, etc. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Two out of two personnel records were missing staff signatures (LIC 501), Health Screening (LIC 503) needs to be filled out by doctor. MEDICATIONS: Medications review began at 1:39 p.m.; medications are centrally stored and locked in a cabinet in the kitchen; medications are labeled and checked for expiration dates. Medications were not properly documented on the centrally stored medications and destruction record (LIC 622). The LPA observed during the medication review the following errors: For two out of six residents, the prescription medication packet did not match the LIC 622. 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 LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster Exit interview conducted. A copy of the report and Appeal rights was issued.