Routine inspection·July 29, 2024

Licensing Program Analyst (LPA) Wong and Nurse Consultant Olive Divranos conducted the Unannounced required annual inspection. LPA arrived unannounced and met with Administrator Brian Buenviaje and assisted with the visit. The purpose for the visit was explained. The facility is licensed for age 60 years and above and all may be non-ambulatory. Currently, the facility has 0 hospice waiver residents and 0 home health residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: 1. Infection Control: The facility staff are using appropriate hand hygiene and wearing gloves while assisting residents. Staff are cleaning and disinfecting once a day and more often for high touched surfaces. Facility has sufficient PPE supplies and has an Infection Control Plan in place. All staff have the health screening and chest x ray result in file. 2. Operational Requirement: The current plan of operation is completed. A fire clearance approved for 18 residents to be non-ambulatory. LPA obtained the updated copy of facility Liability Insurance in the amount of at least ($1,000,000) per occurrence and total amount of aggregate ($3,000,000) is in place. 3. Physical Plant and Environmental Safety: The facility has two single story buildings in the facility lot. The facility is shared with the Adult Residential Facility (ARF) . The RCFE side has a dining area /TV area, with 9 bedrooms (two beds in each room) there are shared bathrooms between rooms; office; kitchen; extra office/storage room. LPA inspected four (4) rooms which include Room#9, #10 and #3 and #4. There is sufficient closet & drawer space in the bedrooms and all bedrooms have required furniture. There is sufficient closet & drawer space in the bedrooms and all bedrooms have required furniture. Beds are equipped with required linen. The hot water temperature was tested between 111.2 and 121.7 degrees F which is over the Title 22 regulation. There are grab bars near the toilet and in the showers and there is a non-skid mat in bathrooms. Residents are provided with their own soap & hand towels. There is a sufficient supply of extra linen. The washer & dryer are located in the rear of the facility. Laundry soap is locked in a cabinet above the washer & dryer. LPA inspected the smoke detectors and they are all working well. LPA also inspected the carbon monoxide detector is mounted on the wall near Room#9 and it's working properly. 4. Staffing: The facility has sufficient staffing in the facility to provide care and supervision to residents. All staff have an updated CPR training certificate. 5. Personnel Record-Training : All staff in the facility are over 18 years old and background check cleared but one of the staff (S1) is not associated with the facility. The administrator is Brian Buenviaje and the administrator certificate is effective through 10/3/25 and he got all the required training hours. The staff files has all the required documents include: employee application, health screening and TB test result. Staff does not have any training hours in file. 6. Resident Right Information: LPA observed the required posters posted in the facility which include Long Term Care Ombudsman located on the big board near the entrance area but LPA did not observe the CCL Licensing Poster and Resident's right poster. 7. Planned Activity: Facility has sufficient space to accommodate for indoor and outdoor activity. LPA also observed the weekly activity calendar and it's posted in the facility. The facility does have an active Resident Council. 8. Food Service: The facility does not have any residents required any modified diet. The facility has ample supply for two days perishable and seven days non-perishable food supply. All the food are stored properly. The kitchen was toured and contained working appliances; refrigerator, stove, oven and contained dishware, cups, plates, utensils, pots, and pans with knives secured and locked. 9. Incidental Medical and Dental: T he facility would assist and arrange resident's medical and dental care appointments and provide transportation for them. All residents medication are centrally stored in the medication office in RCFE building. LPA inspected four resident medication and four resident medication were popped up for more than 24 hour period and also for Resident#1 medication did not pop on 7/23/24. 10. Resident Record-Incident Reports: LPA reviewed four (4) residents files and all have the required documents included: Face sheet, admission agreement, medical consent , ambulatory status, physician report, pre-admission appraisal, needs and service plan and medication list. 11. Disaster Preparedness: The facility does not have an updated Emergency Disaster Plan and facility has two appropriate shelter location for emergency. The last fire/Disaster drill was conducted on 7/15/2024. 12. Residents with Special Health Needs: Facility does not have any home health or hospice residents or any residents required postural support and no residents in the facility with prohibited health condition. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were deficiencies observed during the visit. Deficiencies on 809-D. Exit interview held and a copy of the report and appeal right was provided to Administrator