Routine inspection·April 9, 2024

On 04/09/24 at 8:32 AM, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with Staff Jo-Ann Rito . The facility is an RCFE licensed for (1) ambulatory and (5) non- ambulatory residents. Facility has a hospice waiver for 2. The facility is a one story structure located in a residential neighborhood. It consists of the following: (6) six resident bedrooms, 2 resident bathrooms, 1 staff room, a guest/staff bathroom, living room, dining area, kitchen and detached garage. Backyard had a covered seating area with dining table and six chairs. Kitchen was inspected and observed to be clean and operational. Staff accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, hot water temperature properly measured between 114.4F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions. Knives and toxics were kept in locked storage cabinet. First Aid kit was available. A new fire extinguisher arrived 04/09/24 to replace the one in the kitchen area. Staff tested the carbon monoxide detector and smoke detectors in the house. Both devices were functional. 3 staff records were reviewed, 3 out of 3 staff records had current first aid certificates and required criminal record clearances or criminal record exemptions. Two staff interviews were conducted. 4 resident records were reviewed and, 4 out of 4 resident records had medical assessments and needs and services plans. Two residents’ medication was reviewed. Two residents were interviewed. Deficiencies are being cited based record review in accordance with the California Code of Regulations, Title 22, see LIC809D. The facility has an approved waiver for two (2) hospice residents but the facility is currently caring for three (3) residents on hospice. LPA Cloyd reviewed three hospice binders for Resident #1, #2, and #3. The office staff immediately emailed a letter requesting for a hospice increase to LPA Cloyd. An exit interview was conducted, technical assistance provided, and Plans of Corrections were developed and reviewed. A copy of this report and appeal rights were discussed and left with Staff.