Routine inspection·July 25, 2024

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced required annual inspection on 7/25/2024. LPA Ramirez was met by House Manager Olga Soto and explained the purpose of the visit. The facility is a single story dwelling that is located on a cul-de-sac. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Physical Plant and Environment safety: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be inaccessible to residents. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected four (4) resident rooms. Three (3) out of the four (4) resident bedrooms contained required furniture, linens, and lighting. Bedroom#4 is shared and was observed to contain 1 bed and I recliner. Per staff, resident#2 (R2) wishes to sleep in their recliner and not have a traditional bed. Licensee must apply for this exception. LPA Ramirez will issue Type B deficiency based on this observation. LPA Ramirez observed dresser in bedroom#2 to be in disrepair. LPA Ramirez observed dresser in bedroom#3 to be in disrepair. LPA Ramirez will issue Type B deficiency based on this observation. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. LPA Ramirez observed grab bars near toilets and inside showers. LPA Ramirez observed no-slip mat in showers. LPA Ramirez observed a 7in X 12-in tear on living room loveseat that exposed a yellow foam cushion. LPA Ramirez will issue Type B deficiency based on observation. Food Service: LPA Ramirez observed sufficient supply of nonperishables for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean and within temperatures of 0 degree F (-17.7 degree C), and refrigerators with maximum temperature of 40 degree F. (4 degree C). SEE 809-C for continuation. Residents Rights-Information: LPA Ramirez observed the following postings in common areas throughout the facility: Complaint Poster (PUB 475), personal rights, and nondiscrimination notice. LPA Ramirez observed a facility land line. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. Last documented emergency drills were conducted on 06/08/2024 and 03/06/2024. Residents with Special Needs : No large bodies of water were observed. LPA Ramirez observed signs posted indicating “No smoking - Oxygen in Use” in various locations of the facility. LPA Ramirez observed oxygen tanks in resident rooms secured in stands. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. Auditory devices were observed to be in working order. LPA Ramirez observed full bed rails on R5 bed. R5 is not on hospice and does not have an exception on file for postural supports. LPA Ramirez will issue Type B deficiency based on this observation. R1’s has a diagnosis which requires a medical assessment annually. During records review, R1’s last documented medical assessment was completed on 4/14/2022. LPA Ramirez will issue Type B deficiency based on records reviewed. Health Related Services/Incidental Medical Services: The medications are centrally stored in the medication cabinet, in the facility kitchen area. The facility provides incidental medical services. Staffing: Administrator Certificate for Ralph C Estanislao and it expires on 03/17/2025. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Personnel Records Training: Staff files are maintained at the facility. LPA Ramirez did not observe required annual training for S1 and S2. CPR and First Aid for four (4) out of the four (4) personnel records reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for four (4) out of the four (4) personnel records reviewed. Infection Control: There are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place. Operational Requirements: The fire clearance is approved for six (6) ambulatory residents, which one (1) may be bedridden. This facility may retain no more than two (2) hospice residents. There are two (2) residents under hospice care. Resident Records/Incident Reports: LPA reviewed Resident files for five (5) residents. Resident files are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, Resident Rights were observed. Five (5) deficiencies were observed and cited during inspection. A copy of this report, 809-D and appeals rights was provided.