Routine inspection·September 5, 2024

Licensing Program Analysts (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 10:00 a.m. Upon arrival, LPA Mosley was greeted by staff and called the administrator to inform them of the visit. The administrator was not available and designated staff / caregiver Merle Pacada to lead the tour and sign the report. The LPA 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. Documents obtained: LIC 500, LIC 9020A, Liability Insurance. KITCHEN: The LPA inspected the kitchen/food service area at 10:15 a.m. Knives and sharps were observed in a locked cabinet. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 119.7 degrees Fahrenheit at 10:18 a.m. Cleaning solutions, toxins, chemicals, and hazardous items were inaccessible and locked away inside a kitchen cabinet under the sink. At 10:39 a.m., the LPA observed five (5) cockroaches inside two kitchen cabinets posing a health and safety concern. COMMON AREAS: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 2:35 p.m., smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguishers were observed and fully charged on 8/14/2024. The LPAs observed required postings throughout the common space. The last emergency disaster drill took place on 08/04/2024. Activities were observed in the common areas. Report Continued on LIC 809C... Report Continued from LIC 809... 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. It was observed that a bedridden resident was not in the correct room cleared for bedridden. This was addressed and informed that it is an immediate health and safety risk resulting in civil penalty. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. Between 10:55 a.m. and 11:30 a.m., hot water measured between 118.9 and 119.9- degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. OUTDOOR SPACE: At 12:00 p.m., the LPA observed the back of the facility and front patio area which is partially covered / shaded with trees for the outdoor area for resident use. Staff was made aware that area needs to be cleaned for resident use and proper covering is required. There is a gate on the sides of the house designated for an emergency exit that needs repair. This was addressed and informed that it is an immediate health and safety risk resulting in civil penalty. One of the self-latching gates is not operating properly and does not open smoothly or close at the time of this visit. Staff and administrator was made aware that the gate needs to be fixed immediately. There are no bodies of water on the premises noted at the time of the visit. The garage is not accessible to residents. Laundry units are located outside at the back of the facility. RECORDS: Records were reviewed from approximately 1:00 p.m.- 2:00 p.m. personnel records began at approximately 1:00p.m Resident Records were reviewed at approximately 1:45 p.m.Four (4) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. Report Continued from LIC 809C... Report Continued from LIC 809C... Three (3) personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INTERVIEWS : Two (2) staff interviews were conducted. Four (4) resident interviews were attempted. Two (2) interviews were conducted. MEDICATIONS: Medications review began at approximately 4:30 p.m. The medications are locked in a cabinet near kitchen between staff room and staff bathroom. Medications for four (4) out of four (4) residents were reviewed. Medications reviewed were found to be self administered as prescribed and documented on the centrally stored medication and destruction records. Medications were pre-sorted for two days in advance. Staff was made aware that medication cannot be pre-sorted and made aware of the potential health and safety risk. 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. The Licensee was made aware that failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.