Routine inspection·July 14, 2023

Licensing Program Analyst (LPA) Angel Ascencio arrived at the facility to conduct a required annual visit. The LPA met with Staff member at approximately 9:15 a.m. and explained the reason for the visit. Administrator Susanna Gasparyan arrived at the facility shortly after. The LPA along with Staff toured the physical plant areas inside and outside at approximately 09:30 a.m., to ensure that there are no health and safety hazards. This facility accepts resident under the Assisted Living Waiver Program (ALW). BEDROOMS : There are four (4) bedrooms designated for resident use. Bedroom #1 and #4 are shared. Bedroom #2 and #3 are private rooms. Bedroom # 2 has access to private restroom. Bedroom #3 has a direct access to the outside and the bedroom is considered their bedridden room. All resident 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. BATHROOMS: Resident bathrooms are clean, sanitary, and in operating condition with grab bars and non-skid surfaces. The LPA observed sufficient amounts of soap and paper products. The bathrooms hot water measured between 105.0 degrees Fahrenheit and 120.0 degrees Fahrenheit. KITCHEN : Kitchen knives are stored in a locked cabinet in 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. The supply of perishable and nonperishable food is adequate. Continued on LIC 809-C 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 and carbon monoxide detector was tested and operated normally at the time of visit. Medications were observed to be locked in a cabinet in the kitchen and contained at least 30 days of worth of medication. GARAGE: There is an attached garage containing a laundry room, cleaning supplies, additional Personal Protective Equipment (PPE) and incontinence supplies. The garage was observed locked. The administrator was reminded that it must be kept locked and inaccessible to residents at all times. INFECTION CONTROL: During today’s visit, LPA Ascencio spoke with Administrator regarding the facility’s infection control practices. There is 1 entry into the facility. Upon entry, the facility has a central entry point for symptom screening. The LPA noted that the facility is allowing visitors for both indoor and outdoor visitation. The LPA observed an adequate supply of Personal Protective 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. The facility’s policies and procedures as it pertains to infection control are adequate. The following was observed during today's visit: At 09:35 a.m., during facility tour, LPA observed 5 out of 6 residents with bed rails. At 11:05 a.m., upon further review of resident files, 4 out of 6 residents did not have bed rail order. Continued on LIC 9099 - C At 11:56 a.m., during medication review, LPA observed the Centrally Stored Medication Record was not accurate; Tylenol 500mg was not centrally stored, Eliquis Rx number did not match what was written, 1 Hydrocodone 325mg was not added to the Centrally Stored, 1 Pradexa 150 mg was not centrally stored and 6 out of 6 resident did not have the PRN Authorization letter. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Exit interview conducted and a copy of the report and appeal rights were provided.