Routine inspection·December 5, 2024

Licensing Program Analyst (LPA) Daniel Konishi conducted a required unannounced annual inspection using the Inspection Tool. LPA met with the Administrator, Viviana Reynaga and the purpose of the visit was discussed and assisted in the tour of the facility. The following (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Planned Activities, Food Service, Health Related Services, Incident Medical and Dental, Disaster Preparedness, and Emergency Intervention. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. LPA observed that the facility has an infection control plan in place. Physical Plant/Environment Safety: LPA conducted a tour of the facility and observed the following: The facility is part of a single-story home located in a residential area and contains the following: living room, dining room, kitchen with refrigerator, oven, stove, dishwasher, sink/faucet, (3) resident rooms, (2) bathroom for residents, toilet and washbasin. A back yard with shaded area and seating for resident use. There’s a laundry area; with washer and dryer. All passageways, walkways, driveway, steps and patio are free from obstructions. The front, back and side areas of the house are free of hazards. Hallway linen closet: Contained plenty of linens, towels, and hygiene products. Beds have the required furniture including bedframes, dressers, lamps, night stands, and sofas. Beds have the required linen and the linen is in good condition. Fire extinguisher was observed in the dining room last reviewed 02/07/2024. Physical Plant/Environment Safety [Cont.]: Carbon monoxide detectors are tested and in working condition. Cleaning supplies are kept locked in the hallway away from food supplies. Sharps are kept locked in a kitchen drawer. Shared resident bathrooms were observed to be clean and contained soap and paper towels. Water temperature in this bathroom#1 was measured at 132.5 degrees F and Bathroom #2 was measured at 132.6 degrees F which is in not between the required 105 – 120 degrees Regulations. Operational Requirements: Fire clearance was approved by LA County Fire Department for four (4) non-ambulatory and 1 bedridden. Approved Hospice Wavier for 2. Liability Insurance is confirmed and currently on file. Resident Rights/Information: Residential Care Facility for the Elderly Complaint Poster (PUB 475) posted on the wall. Residents’ Personal Rights posted on the wall. Facility provides internet access for residents. Staffing: A total of three (3) full-time staff members provides care and supervision to the residents. Personnel Records/Staff Training: Administrator’s certificate is active and effective through 02/14/2025. Four (4) staff files were reviewed for criminal background clearance and training. Personnel records have health/TB screenings, employee rights, certifications, and 1st Aid/CPR training. Based on record review, LPA observed Staff #1 (S1) to Staff # 3 (S3) does not have valid 1 st Aid Training in file. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities that are easily accessible. Incident Medical and Dental: Residents are assisted with self-administration of prescription and non-prescription medications. Four (4) centrally stored resident medication records were reviewed. Centrally stored medications are kept in a safe and locked place not accessible to residents in care. Medications are given according to Physician directions. All residents have a Needs and Services Plan, and COVID-19 vaccination cards on file. Staff training was on file. Resident Records/Incident Reports: Four (4) resident files were reviewed containing admission agreements, Identification and Emergency Information, Physician's Report, medical/functional assessments, Appraisal/Needs and Services Plans, TB clearance, Pre-placement Appraisal, personal rights, and medication records. However, based on record review, LPA observed Resident # 2 (R2) negative TB test results not in file. Disaster Preparedness, and Emergency Intervention: A posted Emergency Disaster Plan LIC 610D containing emergency evacuation information was observed. An emergency drill was conducted in 07/07/2024. No manual restraints or seclusion are used with residents in care. Residents with Special Health Needs: The facility is free from odors of incontinence. Currently, one (1) resident is on hospice care and one (1) resident is on home health. Bed rails for mobility assistance were observed in some resident beds but no physician order R2's files. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809-D. Exit Interview conducted and a copy of the report with appeal rights were provided to the Administrator Viviana Reynaga.