Routine inspection·November 20, 2022

Licensing Program Analyst (LPA) V. Maldonado made an unannounced visit to the facility for the purpose of conducting the required annual inspection, using the Infection Control tool to evaluate the facility. LPA Maldonado met with Caregiver Jessica Torres and explained the purpose for the visit. Jessica called the administrator/licensee Ralph Estanislao to notify of the visit. LPA conducted a tour of the physical plant with Jessica, observed the food supplies, COVID-19 procedures, and reviewed client and staff files, and client's medications. The facility has an approved mitigation plan on file. The facility is a two-story home located in a residential area. It is licensed to serve (6) elderly residents, ages 60 and over, of which all may be non-ambulatory and (1) may be bedridden, and has a hospice waiver approved for 2. The home consists of a living room, kitchen, dining room, (6) resident bedrooms, (1) staff room located upstairs, (2) bathrooms, (1) staff/visitor bathroom, a shaded patio in the backyard with seating, and a detached garage. LPA observed all resident bedrooms to have the required furniture, bedding, linens, sufficient lighting, closet space, and additional storage space. (2) resident bathrooms were observed to have a shower, toilet, and wash basin. LPA observed a bottle of cleaning solution underneath the bathroom sink that is located inside bedroom# 1 and a cleaning spray under the sink in the visitor/staff bathroom. The showers accommodate non-ambulatory clients and have the required grab-bars and non-skid mats. The water temperature was tested and measured between 111*F-114*F, which is in compliance. The food supplies was observed to be the required 2-day perishables and 7-day non-perishables. Several fire extinguishers were observed throughout the facility. They had current inspections and were fully charged. The first aid kit was inspected and had the required items, as well as a current first aid manual. All sharps were observed to be locked and inaccessible in a drawer in a file cabinet near the kitchen. Other cleaning supplies were locked and inaccessible, stored in a closet in bathroom# 1. All equipment was operational and in good repair. A hallway closet had additional towels and linens for clients. The smoke/carbon monoxide detectors were tested, were interconnected and operational at the time of the visit. (Report continued on LIC809-C...) Medications are centrally stored in a file cabinet near the kitchen along with resident and staff files. There is a fish pond in the backyard that has a fence around the entire perimeter. The facility has cameras in the common areas. According to staff, the cameras are do not record, they are only used for surveillance. LPA observed a 30-day supplies of Personal Protective Equipment (PPE) stored in the a closet inside bathroom# 1. Additional PPE was observed at the entrance of the facility- the central entry point for screening clients, staff, and visitors. PPE siganage was not observed throughout the facility to promote hand washing, cough/sneeze etiquette, and social distancing, as required by infection control practices. All hand washing stations were noted to have cloth towels in use. Staff indicated they were not aware that paper towels should still be used. Staff immediately removed the cloth towels and replaced them with paper towels. All resident files were reviewed and had updated emergency contact information and health screenings. (2) staff files were reviewed and had Criminal Background Clearances and health screenings. There was no proof of required annual training and certifications. Staff were asked about this and stated that no training has been provided, to date. All resident medications were reviewed. (3) of (4) residents medications were not documented properly and it was found that one of R3's medication (Sertraline HCL 50mg) is not being given as prescribed. Staff stated that R3 requested to take the medication in the evening instead of morning, as is currently prescribed. Staff did not consult with R3's physician and responsible party prior to administering the medication as requested. LPA observed all residents to have full bed railings on their beds, with only (1) resident having a medical order for it, due to being on hospice. (3) residents were missing medical orders for the railings. Per California Code of Regulations, Title 22, and Health and Safety Codes, deficiencies were observed and will be cited on the LIC809-D. An exit interview was conducted with caregiver Jessica Torres and a copy of this report and appeal rights were provided.