Routine inspection·November 4, 2023

On 11/04/23, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with care staff Hazel Luguevarra. LPA Dabuet explained the purpose of today’s visit. The facility is licensed to serve (44) non-ambulatory elderly residents of which (4) may be bedridden ages 60 and above. The facility is approved for (15) hospice residents. Currently, the facility has (5) hospice residents. Rooms #1, #3, #4, and #5 are cleared for bedridden residents. The facility is a two-story structure located in a residential neighborhood. It consists of the following: (22) resident bedrooms. Each room has a bathroom in the room, an activity room, dining room, a kitchen, storage closets, an administrative office, and an open patio area. LPA toured the physical plant. There were no bodies of water on the premises. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident's personal belongings was observed. Bed linens, comforters, and bath towels were stocked during the visit. The resident rooms were inspected: #1, #2, #7 #10, #17, and #19. Bathrooms were operational. A comfortable temperature was maintained in the facility at 72 - 74 degrees F. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Fire extinguishers were fully charged, and smoke detectors and carbon monoxide were operable in each resident's room. The facility has a certificate of liability insurance effective 08/26/23 - 08/26/24. The facility is current on annual license fees. (Evaluation Report continues LIC 809-C) The facility maintains for each resident Centrally Stored Medication Destruction Record and PRN Log. LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA conducted an audit of resident #1-#6 (R1-R6) service files, and staff #1-#6 (S1-S6) personnel files were in maintained in place. LPA conducted (2) residents and (2) staff interviews. DEFICIENCIES: During resident file review between 11:30 AM - 12:15 PM, resident #4 is identified as bedridden in room #7 is in a room not cleared for bedridden. - Type A (Civil Penalty) Hot water temperature for rooms #1 & #2 ranged at 161.2-165.9 at 12:34 PM. - Type A Furnishing of bed mattress, wheelchair, and other furniture obstructing passage way adjacent to room #10 at 12:45 PM. - Type A Bathroom baseboards were rusted and filled with mold in room #19 at 12:47 PM. - Type B Open powder bleach found under bathroom sink in room #7 accessible to residents in care at 12:53 PM. Type A Facility has not conducted a quarterly fire drill consistently. Last drill was performed June 2023. - Type B According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the following deficiencies has been observed and citation issued (ref. LIC 9099-D). An exit interview conducted with Hazel Luguevarra, and a copy of the 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) is cleared. *