Routine inspection·June 1, 2023

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to Wellness Nurse Elizabeth Contreras. Administrator Nelida Arlante arrived shortly after. There are currently 52 elderly residents 60 years and older residing in the facility. Four (4) residents are receiving hospice care, and five (5) residents are bedridden. The following 12 (CARE) tool domains were utilized during the inspection: Infection Control, Operational Requirements, Physical Plant/Environment Safety, Staffing, Personnel Records/Staff Training, Resident Records/Incident Reports, Planned Activities, Food Service, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. COVID-19 screening is still in place. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. Operational Requirements: A current Plan of Operation at the facility is incomplete; only the Dementia plan was reviewed.The Infection Control Plan has been added to the Plan. The facility has a Dementia Waiver in place. A Hospice Waiver for 5 residents is approved. A fire clearance for 100 non-ambulatory residents; of which 10 may be bedridden is in place. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place. A Surety Bond is in place. The facility handles resident monies. Physical Plant/Environment Safety: The facility has a Dementia unit. A hospice waiver for 5 residents is in place. Facility is a 3-story building consisting of 66 resident rooms, 2 activity rooms, TV room, Namaste room, 3 dining rooms, laundry room, and 2 courtyard patio areas. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Cleaning supplies and toxic substances are inaccessible to residents. On 1/24/2023, City of San Gabriel FIre Department conducted an inspection. No violations were noted at the time of the inspection. The facility has fully charged fire extinguishers. The signal system was tested and is operational. Water temperature readings did not measured within the required 105 - 120 degrees Fahrenheit. A total of 7 rooms had water temperatures ranging from 126.5 - 131.7 Degrees Fahrenheit. Dementia unit flooring is in disrepair. Contractor has been hired to make the repairs. Staffing: Sufficient staff members provide care and supervision to the clients. Personnel Records/Staff Training: Administrator completed recertification education, but has not received an RCFE certificate from CCL. Proof that the training was submitted was provided. Staff have criminal background clearance and training. Seven (6 staff files were reviewed. Proof of staff training, health clearance, food handling certificates, and 1st Aid/CPR training was observed. ****Narrative continues next page**** Resident Records/Incident Reports: A total of five (5) resident files were reviewed. They contained admission agreements, Physician's Reports, Appraisal, TB clearance, Functional Capability Assessment, Physician's Orders, medical consent, and medication records. ***A total of 2 Dementia residents had Physician Report's older than 12 months. RCFE complaint poster and Personal rights were observed posted. The Incident report binder was reviewed. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. An activity calendar is posted. The facility does not have an active Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Physician orders for modified diets are on file. Sanitation practices and kitchen cleanliness was observed. Incident Medical and Dental: Five (5) centrally stored resident medications were reviewed; which contained 30-day supply of medications. Medical and dental transportation is provided. Disaster Preparedness: Emergency and Disaster Plan LIC 610E is in place. There is no evacuation chair at each stairway. Citation was issued. The last quarterly emergency drill was conducted on 5/22/2023. Records of resident Appraisal and Needs services plans are part of Emergency training. See next page Residents with Special Health Needs: Eight (8) residents are receiving home health services. Four (4) residents receive hospice care. Postural support physician orders are on file. Half and full bed rails for mobility assistance were observed in resident rooms. Individual Service Plans and Appraisals are on file. No residents have prohibited health conditions. Per California Code of Regulations, Title 22, deficiencies were cited. Exit interview was conducted with Nelida Arlante. A copy of the report and appeal rights were issued.