Routine inspection·May 30, 2023

Licensing Program Analyst (LPAs) Sandra Urena and Elsie Campos arrived at the facility unannounced to conduct a required annual visit at 10:04 a.m. The LPAs met with Administrator Nirvana Ghaemi, and explained the reason for the visit. The LPAs, and the Administrator toured the physical plant areas at 10:20 a.m. inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable food and non-perishable food. At 11:50 a.m., the LPAs and the Administrator observed the kitchen knives to be stored in a locked cabinet drawer to the left side of the stove BEDROOMS: The resident bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are three bedrooms for resident use; room#3 is vacant, room #4 and room #5 are currently occupied as staff rooms. RESTROOMS: Residents’ restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. Proper hand washing signs were displayed, and paper towels were available. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. Continues on LIC 809C... The facility maintained a temperature of 73 degrees. All exits have functioning auditory devices. The LPAs and the administrator observed the required postings in the common area. The backyard has a covered outdoor area equipped with furniture for resident use. The side gate door is self-latching. There were no bodies of water noted. The garage is detached from the home. RECORDS: Residents’ records review began at 11:36 a.m., records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 1:25 p.m. Medications are centrally stored and locked in a cabinet in staff’s room #4. Medications were labeled and checked for expiration dates. Medications are properly documented on the Centrally Stored Medication & Destruction Record (LIC 622), however the LIC622 for each resident, was not updated to reflect the current start of the medication. Three residents’ medications were audited for reliability of assistance with medications. The audit revealed that six out of six prescription medication bottles contained more pills than the actual number stated in the prescription bottle. Per the Administrator, they believe that the staff is transferring pills from a current prescription bottle to a newly received prescription bottle, consequently, the number of pills in the bottles audited did not reflect the amount of pills per the new filled prescription. INFECTION CONTROL : Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. The facility has 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 LPAs discussed the new PIN changes regarding infection control. The LPAs obtained the following documents: LIC500 Personnel Report, LIC9020 Client Roster, Staff schedule. 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. Exit interview was conducted. A copy of the report and appeal rights were provided.