Routine inspection·September 1, 2021

Licensing Program Analyst's (LPA's) Linda Almaraz, Christine Wong, Tony Vasallo and Nina Galarza conducted a visit for the Annual/Required inspection. LPA's met with Licensee, Smita Sanghvi and former Administrator Trupti Mody. Staff member Daisy Fitter and Med-tech Elvira Cortez assisted with the facility walk-through. A tour of the facility includes a single-story building with administrative offices, employees lounge, conference room, and commercial-size kitchen. The second single-story building includes a, medication room, residents rooms, bathrooms, and indoor/outdoor areas. All residents bedrooms have the required furniture for privacy, comfort, and safety. Bathrooms are clean and operational. The following bathrooms hot water temperature was not within the required range of 105-120 degrees F; the first bathroom of the left wing of the building was tested at 125.7 degrees F, bathroom in room #9 which was at 123.8 degrees F, and bathroom in between rooms 4 and 5 was at 121.8 degrees F. Bathroom in room #20, on the right wing of the building was at 102.9 along with bathroom between rooms 18 and 19 which was at 80.1. Bathroom in room #18 on the right side wing has a peeling boarder on the wall of the bathroom floor near the toilet. Bathroom #4 was missing non-skid mat. Both linen closets on the left wing had what appeared to be rat droppings. The commercial-size kitchen was observed for the ability to prepare and serve food. LPA's observed an appropriate food supply of two (2) days of perishables and seven (7) days of non-perishables. There is an additional storage area of food supply for emergency preparedness. All storage areas for chemical compounds, cleaning solutions, toxins, knives or hazardous items are located in the front building. Facility’s central air & heating system is operational. LPA's observed the carbon monoxide device(s) which were tested and appear to be operational. A pull switch, fire alarm sounding device was observed in the hallway/main entrance in second building. Fire extinguishers are fully charged with posted sign. First-aid kit is fully stocked. Facility's call system was not operational. According to Staff #2 the system has not worked for some weeks and they provided small bells to residents until they repair the call system. (Cont LIC 809-C) Landscape and the passageways are free of obstruction. The outdoor activity area is free of visible hazards, debris, and the containers have covered lids. There are no security bars nor weapons or bodies of water (pool/spa) on the premises. LPA's reviewed the facility’s profile, personnel summary report, staff roster & work schedules, personnel files & training records, register of residents, residents’ administrative files & medical records, medications (for proper storage, documentation, and system implementation). LPA's observed the following; Staff #4's personnel file did not have a health screening form. Resident #9's medication (Aquaphor ointment, grratorpium/Albueerol, and PRN Lactulose 10mg/15 solution) was not present at the facility. Resident #6's medication (PRN melatonin 5mg) was not present at the facility. Resident #4's medication (Calmoseptine ointment) was not labeled with the residents name. Resident #6's medication (D-Mannose with Cranberry Dandelion Extract) was not labeled with the residents name. LPA also observed the required mandated documents/poster were not posted in a prominent place, such as Personal Rights and CCL "Let us no" complaint poster. The following deficiencies were observed to be in violation under California Code of Regulation Title 22. Refer to LIC 809D. Due to time constrains the following domains were not completed: Disaster Preparedness and Residents with Special Health Needs and will be reviewed at a later time. Note: Any deficiencies observed during the visit that are not cited today will be cited on the next visit. An exit interview was conducted telephonically due to networking issues at the facility. LPA Almaraz contacted former Administrator Trupti Mody later in the afternoon and also provided a copy of the Facility Evaluation Report via email for a signature. Appeals Rights provided.