Routine inspection·December 5, 2024

On 12/05/2024 at 11:20 AM, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one- year inspection. LPA met with Najma Shaheen, Administrator and the purpose of the visit was discussed. Facility is licensed to serve 12 non- ambulatory residents of which four (4) may be bedriddden (room #1 and room #2 approved for bedridden) and approved for hospice waiver for six (6). None of the residents are diagnosed with dementia or receiving home health or hospice care services. The facility does not handle any of the residents’ money. The facility fees are at a balance of $0. Liability Insurance is current with Kinsale Insurance Company (Policy #0100293191-0) effective 04/03/2024-04/03/2025 for $1,000,000 each occurrence /$3,000,000 policy aggregate limit. The last fire drill was conducted on 12/01/2024. The home is a single story home consisting of: (8) resident bedrooms, (4) full bathroom, a living room, a dining area, a kitchen with two refrigerators, an outside patio area, laundry room outside with an additional refrigerator. At 11:49 AM LPA toured the resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. 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, water temperature measured a 111.5 F, 107.9 F, and 113.4F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. A review of (10) residents service files, (9) staff personnel files and (12 Medication Administration Records (MAR) and did observe discrepancies at the time of visit. Report continues on LIC 809-C Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly, and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. Deficiencies cited under California Code of Regulations (Title 22, Division 6, Chapter 8); LPA observed the following deficiencies: On 12/05/2024 at 11:49 am while LPA was conducting a tour of the physical plant, LPA reviewed and observed: padlock on exterior gate 10 out of 12 residents medication was not listed on the MAR, empty and or not check off by staff on consecutive days. LPA conducted a file review of the 6 out of 12 client files and did not observe an Needs and Services Plan within 30 days after admission date. An exit interview was conducted with Najma Shaheen, Administrator , and a copy of Report and Appeal Rights provided. Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) are cleared.