Routine inspection·July 8, 2021

This page is amended to add additional information and to correct a regulation code on a deficiency cited. Licensing Program Analysts (LPAs) Nune Margaryan and Joe Katrdzhyan conducted an unannounced Required One (1) year - Inspection to this facility. Upon arrival, LPAs met with Caregivers / Reyes Fe and Pasion Conchita who assisted with the visit. The purpose of the visit was explained. The facility is licensed to serve 6 (six) non-ambulatory residents ages 60 and over of which 1 (one) may be bedridden and facility is approved to retain 2 residents on hospice. The facility cares for elderly residents with dementia. LPAs Nune Margaryan and Joe Katrdzhyan inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms, resident bathrooms, laundry room, living room, and outside areas of the facility to ensure compliance with Title 22 regulations. LPAs also conducted the infection control domain tool. A physical plant tour was conducted at 8:45 am. A tour of the single-story facility includes: 6 individual bedrooms for residents, 1 staff room, 3 bathrooms, a living room, kitchen, dining area, and indoor/outdoor activity area. The bathrooms are clean and operational w/grab bars and non-skid surface/mats in place. The hot water temperature was tested throughout the facility and maintained within the required range of 105-120*F. The facility doesn't have a central A/C, however each bedroom is equipped with portable fans and or wall A/C units. The common areas (dining room, living room) appeared to be clean and were properly furnished. Resident rooms were sanitary and had the required furniture and furnishings. The kitchen was observed for the ability to prepare and serve food. LPAs observed a sufficient supply of perishables/non-perishables and emergency food supply. All mandated documents are posted in a prominent place. The facility’s smoke detectors are battery operated and were tested and observed to be operational. The fire extinguisher (located in the kitchen) is fully charged and meets Title 22 Regulations. The first-aid kit (located in the secured medicine cabinet) was observed. There is no pool or other large bodies of water. The facility is required to have auditory devices on all exit doors due to caring for residents with dementia. The following concerns were observed during today's visit; At 10:15AM, LPAs observed the exterior door located on the gate near the patio area was being locked by using a privacy lock from the inside preventing residents from exiting the facility in case of an emergency. At 10:15AM, LPAs observed the self closing mechanism/latch on the exit gate near the patio area was in disrepair as the gate would not self-close. During today’s visit, LPAs observed the auditory chimes on the sliding doors in bedrooms 1, 2 and 4 were missing. The auditory chime in bedroom #7 was inoperable. At 10:35AM, LPAs observed bleach, pine sol, bathroom cleaner, Xtra detergent, WD40, and glass cleaner in the laundry area left unlocked and accessible to the residents. At 10:45AM, LPAs found a sharp knife underneath the kitchen cabinet left accessible to residents. During today’s visit, LPAs observed full bed rails in bedrooms 4, 5 and 7. Per staff, Residents in bedrooms 4, 5 and 7 are not enrolled in hospice and are not receiving hospice services. At 10:50AM, LPAs observed Docusate Sodium 100 MG Capsule (Take one capsule by mouth twice daily) was not administered to R4 on 7/7/21, evening dose. During today’s visit, LPAs observed facility to have 3 residents on hospice (R1 – R3), but the facility has an approved hospice waiver on file for 2 residents. There are deficiencies observed during today's visit and are cited under the California Code of Regulations Title 22 on the LIC 809D. Exit interview was conducted. A copy of the report and appeal rights were provided.