Routine inspection·July 19, 2024

At approximately 9:15 a.m. on 07/19/2024, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with staff and later the administrator and disclosed the reason for the visit. The facility was last visited on 11/22/2022 for a complaint visit. It is a single story building with five (05) bedrooms, two (02) bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for six (06) nonambulatory residents, of which one (01) may be bedridden in Bedroom #5. The facility serves residents with dementia. Approved hospice waivers for six (06). A file review was conducted prior to today’s visit. It was observed that the licensee corporation is in good standing with the Secretary of State but in “not good” standing with the Franchise Tax Board and was suspended on 07/01/2024. At the main entrance, LPA observed a screening station for infectious diseases which contained masks, sanitizer, a digital thermometer, and a visitor sign-in sheet. Postings were observed at the front for the infection control plan, emergency disaster plan, personal rights, house rules, rights of resident councils, non discrimination notice, emergency contacts, theft and loss policy, ombudsman contacts, confidential complaint contacts, facility sketch with emergency exit routes clearly labelled, administrator certificate, facility license, and COVID postings. Walls, floors, windows, screens, and blinds were clean and in good repair. The living room at the front contained furniture in good repair, television, reading material, an appropriately-grated fireplace, and a house telephone. The dining room contained a piano, board games, television, and furniture in good repair. Surveillance cameras were noticed and indicated in common areas. A sufficient supply of linens and towels were located in the hallway. At approximately 9:15 a.m. LPA observed a fully charged fire extinguisher in the kitchen. It was purchased on 02/11/2024. At 9:25 a.m. LPA observed a fully-stocked first aid kit near the office area. Confidential files were also locked in the office area. The garage was locked and contained medications, an extra refrigerator, cleaning supplies, and other extra supplies. At 9:35 a.m. LPA measured the room temperature to be 74 degrees Fahrenheit. Bedroom #5 is cleared for a bedridden resident. At approximately 9:40 a.m. LPA observed a constructed wall in the middle of Bedroom #5 creating two separate bedrooms. An updated facility sketch was not submitted to Community Care Licensing. This deficiency is cited on the attached LIC 809-D page. The auditory alarms on the exits of Bedroom #5 and the dining room were turned off during the visit. This deficiency is cited on the attached LIC 809-D page. Auditory alarms were observed on the bedroom doors of Bedroom #1, Bedroom #2, Bedroom #3, and Bedroom #4. LPA interviewed residents between 9:30 a.m. and 10:30 a.m. Three (03) out of five (05) residents stated the auditory alarms are turned on at night and disturb their comfort. This deficiency is cited on the attached LIC 809-D page. All bedrooms contained a lamp, a chair, nightstand, and a bed with adequate bedding. All furnishings were clean and in good condition. The facility has two (02) bathrooms. One (01) bathroom is private to Bedroom #1, and one (01) is shared. All bathrooms contained liquid soap, paper towels, handwashing instruction sign, trash can with a tight-fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At approximately 9:50 a.m. LPA measured the water temperature in the private bathroom to be 114.4 degrees Fahrenheit. LPA observed an adequate supply of perishable and non-perishable foods in the kitchen. The stove hood was clean. Appliances were in good condition. Sharps were locked below the counter top. Cleaning solutions and medications were locked in the garage. Detergents were locked above the laundry area. A washing machine and dryer were located near the kitchen. Both were in working order. LPA observed a covered patio area in the rear of the facility. The patio contained furniture in good condition. At approximately 10:30 a.m., smoke and carbon monoxide detectors were tested and operational. Detectors were hard-wired and operated simultaneously. Two (02) out of two (02) fire doors closed when the detectors were tested. All emergency exit paths were free from obstructions. The exit gate was unlocked. Evacuation routes were posted. Exit interview conducted. Appeal rights discussed. Copy of report provided.