Routine inspection·September 14, 2024

This document is amended to update the number of approved bedridden residents. On 09/14/2024 at around 9:40 AM, Licensing Program Analyst (LPA) Leandro conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with Licensee Assistant Cecenirose Pare. LPA explained the purpose of the visit and was accompanied by staff inside and outside the facility during this inspection. This facility is licensed to serve 6 bedridden residents ages 60 and above. Complaint with 87705 - Care of Persons with Dementia. Approved for 1 Hospice resident at any given time. There are a total of 5 residents residing in this facility. There are a total of 2 hospice residents residing in this facility. There are a total of 1 bedridden resident in this facility. The facility is a one-story house located in a residential street. The home consists of 4 resident bedrooms, 1 staff bedroom, 3 bathrooms, 1 kitchen, 1 dining/living room area, 1 backyard swimming pool, 1 attached garage,1 backyard patio area with shaded seating. The patio furniture is under a shaded area and accessible to residents. There are no security bars or weapons on the premises. There is construction currently happening in the facility. LPA toured the kitchen area and observed supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Knives and toxins were kept in locked storage cabinet. LPA observed that medications were safe, locked, and inaccessible. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. Documents are posted as mandated. First aid kit is fully stocked with manual. Smoke and carbon monoxide detectors were in compliance and operational. There is a fire extinguisher in the kitchen and it was last serviced on 09/05/2024. 5 out of 5 bedrooms were checked. Mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Bathroom toilets and water faucets worked properly, grab bars were secure, and a non-skid mat was in place. Adequate lighting and toiletries accessible to residents. LPA tested hot water temperature and it measured between 105 and 120 degrees Fahrenheit. This facility provides residents with hygiene products such as feminine napkins, nonmedicated soap, toilet paper, toothbrush, toothpaste, and comb. 5 staff records were reviewed, 3 out of 5 staff records had required documentation. 2 out 5 staff files were incomplete. 5 resident records were reviewed and, 5 out of 5 resident records had required documentation. A technical assistance is being issued for: videoconferencing devices dedicated for client use, maintaining complete files in the facility, and facility construction or alterations. LPA explained to Licensee Assistant to contact their designated LPA Leon and inform them of their construction plan. Email: Mario.Leon@dss.ca.gov Deficiencies are being cited based on LPA observation, record review and interviews conducted in accordance with the California Code of Regulations, Title 22. Violation regarding: Hospice Waiver, Fire Clearance for Bedridden Residents, and Complete & Current Medication Administration Records (MAR). An exit interview was conducted, Plans of Corrections were reviewed and developed. A copy of this report and appeal rights were discussed and left with the Licensee Assistant.