Routine inspection·September 20, 2022

Licensing Program Analyst (LPA) V. Maldonado made an unannounced required 1 year visit to conduct the annual inspection. LPA Maldonado met with caregiver Nenita Capistrano and explained to purpose for the visit. Caregiver phoned assistant administrator Michelle Aguirre and informed her of the visit. LPA used the infection control tool to evaluate the facility. During today's visit, LPA toured the physical plant with caregiver Nenita, food and PPE supplies were observed, COVID-19 procedures were reviewed, staff files were checked for criminal background clearance and training, and residents' medications and files were reviewed for updated emergency information. The facility is licensed for 6 non-ambulatory residents, age range 60 and over -1 may be bedridden and hospice waiver has been approved for 2 residents. Currently there are 6 residents residing in the facility and 4 are on hospice. The assistant administrator Michelle Aguirre arrived at the middle of the visit and assisted with the rest of the visit. The facility consists of 4 bedrooms, 3 bathrooms, a living room, a kitchen, a dining room, a TV room, a backyard with a shaded patio, a body of water was observed in the back yard, and an attached garage. During the tour, LPA observed all walkways, pathways, and entrance/exits free of debris, obstructions, and hazards. There is COVID-19 signage throughout the facility promoting handwashing, social distancing and mask wearing. PPE and hand sanitizer was readily available throughout the facility for resident use. LPA observed the food supplies in the kitchen to be the required 2-day of perishables and 7-day of non-perishables, with a variety of nutritious foods. Medications and sharps were observed to centrally stored and locked in a closet next to the kitchen, inaccessible to residents in care. LPA observed bathrooms#1-#2 to have a working toilet, shower, and wash basin. At 9:17 a.m., bathroom# 2's toilet was observed to not be in good repair as the toilet had no toilet seat or a top pump cover. Bathroom# 2 was also observed to not have a private door and leads to a hallway with a private room. The asst. administrator was asked about this and states the restroom is used only for the one resident with the private room in that area. (Report Continued on LIC809-C...) All bedrooms had the required linens, furniture, and storage space for resident use. The linen closet was observed in the hallway with sufficient additional linens for resident use. The laundry room was observed to have operating machines and in good repair. Cleaning supplies and toxins were also stored in the laundry room, which remains locked and inaccessible to residents in care. A door in the laundry room led to the attached garage which was used for additional storage. Face masks were observed in the garage and additional adult briefs for residents. A fire extinguisher was observed in the kitchen and in the laundry room, operational and fully charged. At 10:22 a.m., LPA reviewed resident files and observed (3) of (6) residents' files to be missing some of the required documents. (2) of (6) dementia care residents do not have an updated physician's report. It was also discovered that there are 2 more residents on hospice than the facility is currently approved for. During review of staff files, LPA observed (2) of (3) resident files to be incomplete and (1) of (3) staff files was not at the facility during the time of the visit. (3) of (3) staff working at the facility during the time of the inspection were found to not be associated to the facility. The administrator was asked about this and states that the 1 staff with no file is only staying here for now. He arrived "last night" and she is not sure if they are going to hire that staff yet. Per Title 22, California Code of Regulations, deficiencies were observed during today's visit and will be cited respectively on the LIC809-D. Immediate Civil Penalties will also be issued in the amount of $500 per each staff (3) that were present and not associated to the facility, during the time of the visit. An exit interview was conducted with assistant administrator Michelle Aguirre and caregiver Nenita Capistrano, and a copy of this report and appeal rights were issued.