Routine inspection·September 7, 2023

Licensing Program Analyst (LPA) V. Maldonado made an unannounced visit at the facility for the purpose of conducting the required annual inspection, using the Care Compliance and Regulatory Enforcement (CARE) Tool to evaluate the facility. LPA met with caregiver, Nenita Capistrano and explained the purpose for the visit. Administrator, Michelle Aguirre was phoned and notified of the visit.. The facility is licensed to serve (6) elderly adults, ages 59 and above. It is approved for (6) non-ambulatory residents, of which (1) may be bedridden and reside in bedroom# 3 only. The facility also has a hospice waiver approved for (2). The facility is a single-story home, located in a residential area. The home consists of (4) resident bedrooms, (2) resident bathrooms, (1) visitor bathroom, a kitchen, living room, dining room, tv room, attached garage, and a fenced pool. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Client Rights/Information, Client Records/Incident Reports, Food Service, Health Related Services, Incident Medical and Dental, Disaster Preparedness, and Emergency Intervention. During today's visit, LPA Maldonado obtained a copy of the client and staff roster, and conducted a tour of the physical plant with assistance of caregiver Nenita. The following was observed: One central entry point for universal entry screening Sufficient PPE stored for 30-days and readily available for use, throughout the home and stored in the garage Physical plant inside and outside is clean, sanitary and in good repair All walkways and pathways observed to be free of obstruction/hazards ( Report Continued on LIC809-C...) All resident bedrooms had the required furniture and the bedding had the required linens Additional linens were observed in a linen closet in the hallway, inspected and in good repair. Cleaning supplies and toxins were observed locked and inaccessible in the laundry room Each client bathroom was equipped with a toilet, shower, and wash basin- all operational and in good repair. Showers had the required grab bars and non-skid mats The water temperature was tested and measured at 105.6*F in bathroom# 1 and 106.7*F in bathroom# 2 Sharps and knives were stored inaccessible in a closet near the kitchen. At 1:30PM, LPA observed 2 kitchen knives and a pair of scissors in a drawer in the kitchen next to the sink where resident utensils are stored. Caregiver Nenita stated they're left there throughout the day and are placed back in the closet at the end of the day. LPA told her they should be inaccessible to residents at all times and she quickly placed them in the closet, locked and inaccessible. At 1:31PM, Food supplies was inspected and LPA observed a quarter gallon of milk, one bottle of juice, a few yogurts and jellos, a few vegetables, and less than 24 eggs in the fridge - facility not in compliance with 2-day of perishables avilable for 6 residents in care Dried and canned foods were observed and facility in compliance with 7-day non-perishables for 6 residents in care Kitchen was observed clean/sanitary, and flatware, utensils, and cups were available and in good repair- sufficient for clients in care All the required postings were posted throughout the home The washing machine and dryer were observed in the garage and clean and operational at the time of the visit 3 fire extinguishers were observed throughout the facility, fully charged with current inspections At 1:43PM, LPA discovered that a closet located inside of Resident#6's private bedroom, was converted into a staff room. According to caregiver Nenita, staff rest there. The closet room is equipped with a bed, a TV, and storage space above the bed that has folded clothing throughout. It appears someone is occupying the room long-term. At 1:45PM, LPA observed a padlock on the gate located on the side of the house that leads to the street. Caregiver was asked why the gate was locked, to which she responded that it is to keep wildlife out of the home. The facility does not have fire clearance for locked perimeters. At 2:01, (6) resident files were reviewed, LPA found that files were not complete and were missing Admissions Agreements, Needs and Services Plans, Physician's Reports, and Pre-Placement Appraisals It was discovered that (3) residents are currently on hospice, and the facility only has a waiver approved for (2) It was also discovered that (6) residents have bedrails on their beds, however, only (3) have written orders indicating the need for them. Per California Code of Regulations, Title 22, deficiencies were observed and will be cited during today's visit. Due to time constraints, LPA was unable to complete the annual inspection and will return at a later time to complete it and issue Civil Penalties for repeat violations within a 12 month period. An exit interview was conducted with caregiver Nenita Capistrano, and copy of the report and appeal rights was provided.