Routine inspection·February 20, 2025

Licensing Program Analysts (LPA)s Valeria Conway and Martha Arroyo arrived at the facility at 9:15 A.M., for an unannounced annual inspection. Upon arrival, LPAs met with Evelyn Pena, Wellness Director and at this time the reason for the visit was explained. Administrator Yehuda Cohen was contacted via telephone and arrived at 10:20 A.M. Entrance interview conducted. Beginning at 11:05 A.M., the LPAs along with the 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. The following was observed: Initial test (5-Year) fire sprinkler inspection was completed on 02/16/2022. Fire permit completed on 1/4/2025 and valid through 12/31/2025. Fire safety concerns were noted by Fire Inspector Benjamin Guzman on 01/29/2025. Facility is licensed for 46 ambulatory residents, of which 10 may be bedridden. Fire extinguishers throughout the building were observed to be fully charged and last serviced on 09/09/2024. At 11:10 A.M., dining room carbon monoxide alarm was tested but not functioning; at 11:35 A.M. hallway carbon monoxide alarm was tested and properly functioned at the time of the visit. Technical violation (TV) issued. The Facility does handle cash resources for some of the clients. Surety Bond is current. T his facility doesn’t have a staff room, facility will provide 24/7 care. Continued on LIC 809-C Continued from LIC 809 BEDROOMS: A random selection of 6 (six) resident rooms were observed. All rooms were furnished appropriately with clean linens, and sufficient lighting. LPA Conway observed a bed not to have fitted sheets. Technical violation (TV) issued. LPAs observed bathrooms with grab bars and slip resistant mats. LPAs observed one shared bathroom not to have a shower head and shower curtain. Between 11:41 A.M. and 12:00 P.M. hot water temperature was checked in multiple randomly selected rooms and measured within the required range of 105 to 120 degrees Fahrenheit. COMMON AREAS: The facility is a one-story building. The facility contains multiple common areas, which were all observed to be clean, furnished appropriately and in good condition at the time of the visit. There were no obstructions and/or tripping hazards throughout the facility. All required postings were observed in the common area. The facility maintained a comfortable temperature of 73 degrees. LPAs observed cameras throughout the common areas only. Administrator states that cameras are not functioning at the time of the visit. Additionally, next to the dining room, LPAs tested a delayed egress system at 12:10 P.M. which functioned properly at the time of the visit. Facility provides sufficient space to accommodate both indoor and outdoor activities. OUTSIDE AREA: The LPAs and Administrator toured the outside areas of the facility. The LPAs observed appropriate outdoor furniture, with a covered shaded area for resident use. LPAs observed a locked shed containing emergency food. LPAs inspected can foods for expiration dates. LPAs observed expired food items. Expired items were discarded at the time of the visit. Additionally, there is a detached building belonging to the skilled nurse facility next door where a sufficient supply of emergency water was observed. LPAs observed a fenced back patio with a double locked gate. There were no bodies of water noted. KITCHEN AND DINING ROOM: LPAs observed the kitchen and dining room. Food is prepared in the neighboring facility, Grand Valley Health Center. On 03/05/2024, Administrator submitted an offsite kitchen waiver to LPA Yee, which is still under review. Facility dining room and commercial kitchen were inspected and found to be in compliance with Title 22 regulations. Continued on LIC 809-C Continued from LIC 809-C RECORD REVIEW: Starting at 12:07 P.M., LPAs reviewed 6 (six) staff files and 6 (six) resident files. Files were reviewed for, but not limited to: Physician's Reports, Personal Rights, Admission Agreements, staff training records, health screenings, TB tests, and background clearance. Record review of resident files revealed that Resident #1’s (R1)’s physicians report, dated 02/12/2025 indicating R1 not having capacity for selfcare and R1 is neither under hospice care nor have an approved exception on file with the Department. Additionally, LPAs observed two (2) out of six (6) residents to be non-ambulatory. MEDICATIONS: Medication review began at 1:30 P.M. Medications are stored a locked med room inside the medication cart. LPA Conway observed medications for 7 (seven) residents. During medication audit it was observed that five (5) out of seven (7) medication bubble packs contained extra doses of medication. The Wellness Director was unable to provide an explanation as to why the medications were not administered to residents at the prescribed times. Furthermore, the Wellness Director confirmed that there are currently no residents refusing their medication. LPAs also reviewed the facility's Emergency Disaster Plan, which was observed to be complete and updated on 2/3/2025. Emergency Disaster drills are conducted quarterly, with the last drill documented on 12/14/2024. During today’s visit LPAs obtained a copy of the facility’s LIC 500, resident roster, surety bond and liability insurance. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.