Routine inspection·March 5, 2024

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Required 1-year Visit on 03/05/2024. LPA was met by Administrator Francis Mejia and explained the purpose of the visit. The facility is licensed to serve six (6) residents over the age of 60, of which one (1) may be non-ambulatory and has a hospice waiver approved for two (2). LPA OBSERVATIONS: The facility is a single-story dwelling located on a residential street and consists of four (4) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, kitchen, dining room, living room, attached garage, front yard, and backyard. LPA Ramirez observed auditory devices on entry of door to be operational, sliding door and exits. Front Yard: Was clean and well maintained. No hazards were observed. Kitchen: LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located in kitchen cabinet, to be inaccessible to five (5) out of five (5) residents in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located under kitchen sink, to be inaccessible to five (5) out of five (5) residents in care. Dining Room/Living room: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed to have plenty of seating and lighting. Nearby thermostat was observed to read 70-degree F. Linen Closet: Contained plenty linens, towels, and hygiene products. SEE 809-C for continuation. Resident Rooms 1-4: LPA Ramirez inspected four (4) resident bedrooms and observed all bedrooms to contain required furnishings, lighting, and linens. Bathrooms 1-3: Water temperature in two (2) resident bathrooms were not within 105-120 degrees F. Water temperature I bathroom#1 was measured at 127.8 degrees F and 127.6 degrees F in bathroom#2. LPA Ramirez will issue Type A deficiency. Bathtoom#3 is accessible only to staff. LPA Ramirez observed keys to unlock chemicals in bathroom#2 to be accessible to residents in care. LPA Ramirez will issue Type A deficiency. Backyard: Was clean and well maintained. No hazards were observed. Plenty of shade and seating was observed. LPA Ramirez observed staff room near garage area. According to Administrator Mejia, the facility does not have a city permit for additional room. On 10/31/2022, Case Management visit with deficiencies was conducted. Facility was previously cited for not having city building permit for additional staff room. LPA Ramirez will issue Type B deficiency. Garage: Access to garage was observed to be inaccessible to five (5) out of five (5) residents in care. Extra PPE supplies observed in this area. Emergency Drills/Emergency Disaster Plan/First Aid Kit: LPA Ramirez observed Emergency & Disaster Plan (LIC 610E) during inspection. Last two (2) fire drills were conducted on 01/05/24 and 12/05/23. LPA Ramirez observed a First Aid kit in medication closet. Carbon Monoxide Detectors/Fire Alarm/Fire Extinguisher: LPA observed carbon monoxide in hallways and smoke detectors were observed to be operable. Personnel Records: Personnel records are maintained at facility. LPA Ramirez reviewed staff files for three (3) staff. LPA Ramirez observed Administrator’s certificate for Francis C Mejia with an expiration date of 05/22/2024. LPA Ramirez observed required annual training, CPR and First Aid for two (2) out of the three (3) personnel records reviewed. Resident Records: Five (5) resident files were reviewed. Admissions Agreement, Medical Assessment, Consent Forms, Appraisal and Needs and Services plan, I.D and Emergency Information, TB Test, and Personal Rights Form were observed in resident records. Liability Insurance & Infection Control Plan: Facility has current liability insurance on file. LPA Ramirez observed updated infection control plan. Deficiencies were cited during visit. Exit interview was conducted. A copy of this report, 809-D and appeals was provided.