Routine inspection·August 21, 2024

Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced One (1) year Required visit at this facility. LPA met with the administrator Eva Calko who granted access and LPA explained the purpose of the visit. This is a single story home with three (3) bedrooms for resident use and two (2) bathrooms with an approved fire clearance for two (2) non ambulatory and one (1) bedridden resident for a total capacity of 3 residents. Upon entry LPA observed administrator was preparing medications and updating Medication Administration Records (MARs) for morning medication and to add medication that was delivered. One staff#1(S1) was attending to the residents while administrator was documenting medication information. A tour of the physical plant was conducted at 09:39 a.m. with the administrator and the following was observed: There is only one entrance being utilized at the facility, there are required postings posted by the main door. Kitchen: LPA conducted a tour of the kitchen and observed there to be a sufficient supply of two day perishables and seven day non-perishable foods, properly stored. Food storage and preparation areas are clean. LPA observed all knives and sharp objects, locked in a kitchen cart inaccessible to residents in care. There is one (1) fire extinguisher located in the kitchen observed to be fully charged with service date 06/26/2024. LPA observed the first aid kit in a kitchen cabinet. Common areas: LPA observed the living area and dining area to be clean. The furniture was in good repair and sits the capacity of the facility. Bedrooms: LPA inspected three (3) resident bedrooms. Three (3) out of three (3) bedrooms are for private use. LPA observed each resident room to be properly furnished with beds, appropriate night stand, chair, bedding and with sufficient lighting and storage. (Continue to LIC809-C) LPA observed the administrator test a smoke detector at 9:58 a.m. Smoke detectors are interconnected located through out the facility. LPA observed detectors functioning properly. LPA observed door alarms on exit and entry doors on and functioning properly. LPA tested one (1) carbon monoxide detector and it appeared to be functioning properly. Bathrooms: The facility has two (2) bathrooms. One (1) is located in the staff's private bedroom. LPA observed resident's bathrooms to be clean and properly supplied with hand soap, toilet paper, paper towels and a trash bin with a lid. LPA observed a non skid shower mat and proper grab bars by shower and toilet. LPA tested the hot water temperature in the resident's bathroom and it read 115.3 degrees Fahrenheit at 10:03 p.m. Surrounding Grounds : Entry and exits were free of obstructions. There is a covered patio with appropriate furniture for residents to use. There are no bodies of water. Resident/Staff Records: At approximately 10:40 a.m. LPA reviewed resident and staff records to insure compliance with licensing forms. LPA observed a full bed rail on Resident #2's (R2's) bed. LPA's review of R2's records revealed R2 has an order for a bed rail but it does not specify the length and R2 is not receiving hospice care services so therefore R2's bed should not have a full length bed rail. Administrator informed LPA, R2 is a fall risk and a full bed rail is a precaution. Review of R2's physician's report revealed a diagnosis of Dementia and that it was completed on 05/06/2023. Administrator informed LPA they would work with R2's family to schedule a doctors appointment to conducted an updated medical assessment. Review of three (3) staff records revealed S1 has not been finger printed and did not poses a background clearance prior to working at this facility. Administrator admitted they are still waiting for S1 to complete required documentation. Upon further review administrator failed to obtain a copy of S1's health screening as well. Medications : Centrally stored medications are maintained locked in a kitchen cabinet. Centrally Stored Medication and Destruction Records were reviewed. Facility keeps written records and Medication Administration Records (MARs). Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were deficiencies observed during todays visit (refer to LIC809-D). Exit Interview Conducted. Appeal rights provided. A copy of this report provided.