Routine inspection·May 10, 2023

Licensing Program Analyst (LPA) Angel Ascencio arrived at the facility unannounced to conduct a required annual visit at 9:35 a.m..The LPA met with staff and explained the reason for the visit. The Administrator Serguei Kalistratov arrived shortly thereafter. The LPA, with the guidance of staff, 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. BEDROOMS: All client rooms are set up with beds, night stands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds. In addition, no bedroom was used as a passageway to another room, bath or toilet. There are six (6) total bedrooms for resident use – all resident rooms are private rooms. RESTROOMS: There are two (2) total bathrooms at the home. The resident bathroom has a shower with non-skid materials. The toilet and shower have grab bars. During the visit, the LPA observed signs in all of the bathrooms pertaining to proper hand hygiene. All cleaning supplies were inaccessible to client in care. In addition, restroom hot water measured under 120.0 degree F. KITCHEN : Kitchen knives are stored in a locked closet by the kitchen. The supply of dishes, utensils, pots, pans and drink ware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. Continued on LIC 809 - C The supply of perishable and nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Kitchen, laundry and house cleaning supplies are stored in a locked cabinet. No flies or other vermin were observed. Hot water in kitchen was measured at 104.0 degrees Fahrenheit. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, common seating area and dining room furniture was observed to be in good condition. Chairs were observed to be at least 6 (six) feet apart for social distancing. The LPA observed the required postings in the common hallway. Fire extinguishers were observed to be serviced within the last year. The facility smoke alarm system is hardwired and operated normally at the time of visit. Medications were observed to be locked in a closet by the kitchen and contained at least 30 days of worth of medication. The garage door was observed and contained a locked cabinet for laundry supplies. The backyard has a covered outdoor area equipped with furniture for client use. There were no bodies of water noted. INFECTION CONTROL: During today’s visit, the LPA spoke with the Staff regarding the facility’s infection control practices. Upon entry, the facility had a central entry point for symptom screening, temperature checks, and sanitation station. The LPA observed 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 does not have a confirmed case of COVID-19 at this time and the LPA reviewed facility’s policies and procedures as it pertains to infection control. 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. Starting at 10:01 a.m., during resident file review, five (5) out of six (6) residents did not have their Needs and Service Plan signed by the residents responsible party. In addition, one (1) resident did not have a current Needs and Appraisal based on Change in Condition. Continued on LIC 809 - C At 10:20, during resident file review, LPA did not observe bed rail orders for three (3) out of the five (5) resident. At 10:47 a.m., during resident file review, one (1) resident did not have Tuberculosis test documented. At 11:00 a.m., LPA did not observed quarterly emergency drills. At 12:00 p.m., during staff file review, all staff member (7) did not have their initial 40 hours of training and their continued 20 hours annually. In addition, LPA did not observe Dementia required training for all staff. At 12:30 p.m, during staff file review, six (6) Staff did not have a their Tuberculosis documented. At 3:00 p.m., during medication review, LPA did not observe PRN Authorization Form for six (6) out of 6 residents. Administrator Serguei Kalistratov could not join the LPA for exit interview, but authorized staff member to sign the documents. Exit interview conducted and copy of the report and appeal right were issued.