Routine inspection·June 7, 2024

Licensing Program Analysts (LPA) Erik Zaragoza conducted an unannounced Required 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA explained the purpose of the visit to Verna Chisholm, caregiver for the home, and was granted entrance to the facility. Administrator and Joanna De Castro arrived shortly thereafter. There are six (6) residents currently living in the facility. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: · Infection control plan is on file. Physical Plant/Environment Safety: · The facility is a single-story home located in a residential neighborhood. It is licensed for a capacity of six (6) non-ambulatory residents, and is also approved for a hospice waiver for three (3) residents, however there are two (2) residents residing in the home that are identified as bedridden in their physician’s report which violates their fire clearance. The facility consists of a living room, a dining room, ten (10) resident rooms, multiple residents bathrooms which LPA measured and most reached the required range of 105 – 120 degrees Fahrenheit except for the bathroom in bedroom #3 which does not have operational hot water. Additionally, there was observable mold found on the ceiling of the residents’ shower room. The facility also has a kitchen, a dining room, a living room, a backyard area which contains a shed for tools, and a detached garage that contains the facility’s laundry machines and emergency food supplies, along with the facility’s chemicals and cleaning supplies. Knives and sharp objects are kept locked in the a locked cabinet in the kitchen. The facility was observed to be in good repair. · The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. The facility has one (1) fully charged fire extinguisher located in the kitchen of the facility. There were no sharp objects that were left accessible to residents. · One (1) of the restrooms toured did not reach the required hot water temperature reading of 105 - 120 degrees Fahrenheit. Operational Requirements: · The Program Design was reviewed. · Fire clearance was approved by LA County Fire Department for a capacity of six (6) non-ambulatory residents, and is also approved for a hospice waiver for three (3) residents · Care and supervision to meet the clients’ needs was observed. Staffing: · Twenty-two (22) full-time staff members provide care and supervision to the clients. Personnel Records/Staff Training: · Five (5) staff files were reviewed for criminal background clearance and training. · Personnel records have health/TB screenings, certifications, and 1st Aid/CPR training. · Administrator’s certificate expires on 3/21/2025. Resident Rights/Information: · Physician orders were reviewed for six (6) resident files. · Medications were also reviewed for six (6) residents. Resident Records/Incident Reports: · Six (6) resident files were reviewed containing admission agreements, Physician's Report, medical/functional assessments, Needs and Services Plans, TB clearance, Appraisal/Needs and Services Plan, personal rights, medical consent, and medication records were reviewed. · Three (3) residents diagnosed with Dementia did not have their physician’s report or appraisal updated within the past twelve (12) months as required by Title 22 regulations. Food Service: · The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Incident Medical and Dental: · All residents have an Appraisal/Needs and Services Plan on file. · Staff training was on file. Disaster Preparedness: · Emergency and Disaster Plan was publicly posted and found within the facility. · An emergency and disaster drill was last conducted on 5/30/2024. Planned Activities: · Sufficient Space is provided to accommodate both indoor and outdoor activities. · Sufficient equipment and supplies are provided to meet the requirements of the activity program. Residents with Special Health Care Needs: · The facility has a non-ambulatory fire clearance for each room that will be used to accommodate residents with a dementia diagnosis. · There was no documentation on file for four (4) out of five (5) staff members that they have conducted their required annual retraining related to Dementia Care, Hospice Care, Postural Supports, and Restricted Health Conditions. · There is an adequate number of staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her appraisal. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809Ds. Exit interview held and a copy of the report along with appeal rights were provided.