Routine inspection·June 25, 2024

On 06/25/24 Licensing Program Analyst (LPA) Evelin Rios arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA was greeted by caregiver. Caregiver contacted the administrator and informed them LPA was at the facility. Administrator, Natividad Arayata and Licensee Beatriz Vasquez met LPA shortly after. LPA Rios explained the purpose of the visit. This is a six (6) bedroom four (4) bathroom Residential Care Facility for the Elderly. Facility has an approved fire clearance for 5 non ambulatory and 1 bedridden resident for a total capacity of 6. At 11:30 a.m. LPA conducted a physical plant tour to ensure the health and safety of the residents in care. The following was observed: Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of 2-day perishable and 7-day non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen and medications were observed locked in a kitchen cabinet. Bedrooms: There were six (6) bedrooms of which five (5) are designated for residents' use and one (1) is shared. Three of the bedrooms are currently occupied. Two (2) rooms are currently vacant. Rooms occupied by residents were properly furnished with appropriate bedding, linens, sufficient lighting and required furniture. Hallway closet by the bedrooms was observed to store extra linens. The facility keeps a comfortable temperature of 72 degrees Fahrenheit. Bathrooms: There are four (4) bathrooms. One (1) is located in the shared bedroom. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was taken from two (2) bathrooms at 12:00 p.m. and read between 110.6 and 111 degrees Fahrenheit within compliance. (Continued on LIC809-C) Common Areas : These included the living areas and dining areas. The common areas were clean, clear of clutter and properly furnished. Dining table and couches sit the capacity of the facility. Living area has a fire place secured with a screen. The auditory alarms on all exit doors were on and functional at the time of the visit. The smoke alarms are hard wired and interconnected. Administrator tested the smoke detectors and carbon monoxide detector at 12:20 p.m. and they were observed to be functioning properly. The fire extinguisher is located in the kitchen and was observed fully charged. Surrounding Grounds : Entry/exits were free of obstruction. The outdoor area was free of hazards. Garage/Laundry: The laundry room is kept locked and inaccessible to residents in care. Detergents and cleaning products are kept in the laundry room locked. The garage is accessible and the facility stores extra paper towels, toilet papers, emergency water and linins. Staff Files and Facility File : At 12:27 p.m. LPA also conducted a file review of staff records and facility records to insure forms and training are up to date and compliance with licensing forms. Resident Files : At 1:15 p.m. LPA conducted a file review of resident records to insure compliance of licensing forms. According to resident#1's (R1) and resident#2's (R2) most recent physician's report for the purpose of fire clearance both R1 and R2 have bedridden checked off under Ambulatory Status. According to the administrator the physician marked the incorrect ambulatory status and it should have been non ambulatory as per the administrator both R1 and R2 can independently reposition themselves in bed and only require assistance with transferring to and from bed. LPA observed R2 able to reposition themselves utilizing bed rails. LPA also observed both R1 and R2 in non ambulatory bedrooms. According to facility's approved fire clearance, bedroom #1 is designated as the bedridden bedroom. Medications : At 3:11 p.m. Medication and Medication Records were reviewed for proper documentation. Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiency observed during the visit (refer to 809-D). Exit Interview Conducted. Appeal Rights provided. A copy of the report Issued.