Follow-up·December 14, 2023

Licensing Program Analyst (LPA) David España is conducting a case management-other visit due to LPA observations on 12/13/2023 deficiencies not related to a complaint that is being investigation today. (Control # 11-AS-20231205153025) LPA met with S#1 who assisted with visit. Upon arriving at the facility, LPA met with S#1 and S#2 who assisted with the visit. The purpose of today’s visit was discussed. Upon arrival at the facility, LPA conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection. LPA was granted access and allowed to enter the facility to conduct inspections. On 12/13/2023 Licensing Program Analyst (LPA) David España confirmed there were Thirty-Six (36) total residents in care. LPA confirmed there are Ten (10) total staff employed as of 12/13/2023. LPA confirmed there is only One (1) resident in care who receives oxygen as of 12/14/2023. LPA confirmed there are Six (6) total staff working at the time of visit 12/14/2023. LPA confirmed there are Twenty-Two (22) total residents in care with dementia at the time of visit 12/14/2023. LPA confirmed there are Twelve (12) total residents in care with wheelchairs at the time of visit 12/14/2023. LPA confirmed there are Seventeen (17) total residents in care with diapers at the time of visit 12/14/2023. The LPA also reviewed the following documents provided by Muriel Cabacugan Assistant Administrator (S1): Staff roster and Client roster. Observation on 12/13/23 at 10:25am made while conduction a walkthrough of the physical plant, LPA observed Room #16 and Room #15 front doors and Room walls with large holes in the drywall that needs maintenance. LPA and S#1 observed Room #3 window bathroom screen missing. LPA and S#1 observed bathroom window not working (did not stay on its track). LPA and S#1 also observed Room #14 and Room #13 had a strong urine odor in both rooms. LPA and S#1 observed private room #12 missing window screen next to the bathroom. LPA and S#1 observed outdoor walkways with materials with little accessibility towards exit of facility (back of facility). LPA and S#1 also observed materials with little accessibility entering the laundry area towards side of facility. Continued on LIC 809-C LPA and S#1 observed during tour observed front and side of facility, and the left-hand side of the facility, noted overgrown grass with no access to the length of the facility. LPA and S#1 noted debris and yellow overgrown grass. LPA interviewed S#1 about access to the side of facility, and S#1 stated there was no door access to the area. LPA noted that flammable grasses blanketed the side of the facility. Lastly, LPA and S#1 observed in the front yard with overgrown plants. LPA and S#1 toured the back side of the facility and noted that the trash bins were not closed. LPA and S#1 observed flies and insects within the facility. LPA and S#1 additionally noted pigeons and pigeon cages within the facility. The following deficiency is being cited in accordance with California Code of Regulations, Title 22, Division 6 Chapter 8 Article 05. Physical Environments and Accommodations 87303 (a-e) Maintenance and Operation and Title 22, Division 6 Chapter 8 Article 05. Physical Environments and Accommodations 87303(f) (1-2) Maintenance and Operation on the LIC 809D. Exit interview was conducted with facility representative and appeal rights as well as report was provided.