Routine inspection·October 3, 2024

On 10/03/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with house manager Nelson Ortega. LPA explained the purpose of today’s visit. Ortega contacted the administrator Virgina Asis who later was present during the visit. The facility is licensed to operate for (6) non-ambulatory of which (2) maybe bedridden elderly adults ages 60 and above. Currently, the facility has no hospice resident in care. The facility is approved for (6) hospice residents. The facility consists of two (2) floor levels: the first floor consists of (3) resident bedrooms all of which are shared rooms, (2) restrooms, kitchen, dining room, living room, and attached 2 car garage. The second floor consists of 3 bedrooms occupied by staff. LPA toured the physical plant. There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the resident's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 114.8 degrees F. A comfortable temperature of 77 degrees F. was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene 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 extinguisher were charged. The facility has conducted emergency fire drills on 04/06/24. A review of the Medication Administration Record (MAR) was observed to be maintained in order. (Evaluation Report continues LIC 809-C) LPA observed First Aid Kit was maintained. A working landline phone was operational. The facility had operational smoke and carbon monoxide in bedrooms and common areas. The facility has current liability insurance on file effective 08/19/23 through 08/19/24. The facility is current with CCLD annual license dues. An audit of residents #1-#4 (R1-R4) service files and staff #1-#4 (S1-S4) personnel files. The facility has the current administrator's certification on file for Virginia Asis #7010477740 Expiration 09/08/25. DEFICIENCIES: Non-operable smoke detector in resident room #1. Disinfectant Spray left out on top of kitchen trash bin accessible to resident in care. No window screen for resident room #2. Staff #1 and #2 did not have direct care training completed. Staff # 2 and #4 did not have current CPR/First Aid completed. Resident #3 not on hospice care had full extended bed rails without physician's prescription. Facility had no night "awake" staff for (3) out of (4) residents diagnosed with Dementia. Civil Penalties issued for repeat violations. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the following deficiencies has been observed and citation issued (ref. LIC 809-D). An exit interview conducted with Nelson Ortega, 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. *