Routine inspection·September 26, 2023

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 9:37 a.m., the LPA met with staff and explained the reason for the visit. At 11:30 a.m., the Licensee arrived at the facility. At 10:30 a.m., the LPA, along with staff, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 10:33 a.m., hot water measured at 105.4-degree Fahrenheit. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away inside a kitchen cabinet. At 10:35 a.m., the LPA observed three (3) cockroaches inside a kitchen cabinet. During the time of the visit, the Licensee began to remove all items inside the kitchen cabinet. The Licensee explained that the facility does receive pest control services and the next scheduled service is for September 28, 2023. BEDROOMS: The facility is a single-story residential home with seven (7) bedrooms, five (5) for resident use and two (2) for staff use. The facility has four (4) bathrooms, two (2) for resident use and two (2) for staff use. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. Between 10:43 a.m. and 10:56 a.m., hot water measured between 125.4 and 130.6-degree Fahrenheit. The Licensee was made aware of the water temperature and stated that he will adjust the temperature. The sinks had sufficient liquid soap, and paper towels. Continued on LIC 809-C. OUTDOOR SPACE: At 10:48 a.m., the LPA observed the back of the facility and front patio which has a covered outdoor area for resident use. There are two gates on the sides of the house designated for an emergency exit. There are no bodies of water on the premises. The garage is not accessible to residents. Laundry units are located outside at the back of the facility. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last serviced on 07/12/2023. Signs are posted throughout facility to promote handwashing, and cough/sneeze etiquette. Exit has functioning auditory devices. At 2:45 p.m., fire alarm/ carbon monoxide detectors were tested and functioned properly. Medications and first aid kits are located in a locked hallway closet. Between 10:52 a.m. and 11:15 a.m., the LPA conducted interviews with three (3) staff and one (1) resident and attempted to interview an additional two (2) residents. Between 12:41 p.m. and 1:48 p.m., the LPA conducted a review of medication and medication documentation with staff for five (5) residents and observed the following: Resident #1 (R1’s) Hydrochlorothiazide 12.5 MG tablet had 17 tablets remaining, however the medication was started on 09/12/2023 and the quantity was 30. Resident #2 (R2’s) Allopurinol 300 MG tablet had 16 tablets remaining, however the medication was started on 09/16/2023 and the quantity was 30. RECORD REVIEWS: Between 1:50 p.m. and 3:28 p.m., the LPA conducted a file review for all residents and staff regularly schedule. Staff records were reviewed for documents including, but not limited to health screening, TB test, staff training records, and fingerprint clearance. The following was observed Staff have current first aid and required documents. However, one (1) staff file reviewed did not contain proof of health screening and negative tuberculosis test. Additionally, the annual training was completed for all staff, however the numbers are incorrect. The Licensee will correct and send the corrected training to the LPA. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, and consent forms. The following was noted: Two (2) out of five (5) residents with dementia diagnosis did not have updated medical assessments. Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8 and California Health and Safety Code the following deficiencies were cited (refer to LIC 809-D). The Licensee was made aware that failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report of provided.