Routine inspection·November 27, 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 Compliance and Regulatory Enforcement (CARE) Tool, to evaluate the facility. LPA Maldonado met with Caregiver, Angela Gavilanes, and explained the purpose for the visit. Administrator, Ralph Estanislao, arrived shortly after and assisted with the visit. During today's visit, LPA Maldonado conducted a tour of the physical plant with Ralph, observed the facility food supplies, reviewed (6) resident medications, (6) resident files, (3) staff files, and conducted interviews with (3) staff and attempted interviews with (6) residents. The facility is a two-story home, operating as a Residential Care Facility for the Elderly. It is licensed to serve (6) older adults, ages 60 and over. It has an approved dementia care plan. There is a fire clearance approved for (6) non-ambulatory residents, of which (1) may be bedridden, and has a hospice waiver approved for (4). There is currently (1) resident receiving hospice services. An approved mitigation plan is in place and Infection Control plan has been submitted to the department for review. The facility has an active and current liability insurance policy on file. 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. Upon arrival to the facility, LPA was unable to enter the property and observed the front gate locked. LPA Maldonado had to ring the doorbell and a caregiver had to open the gate by key to allow LPA entry. LPA asked Ralph the reason for the locked gate. He stated it was due to safety precautions as there are transients near the home. The facility does not have a fire clearance approved for locked perimeters. LPA observed all resident bedrooms to have the required furniture, sufficient lighting, and storage space. (5) of (6) residents' beds were observed to have bed rails. However, Resident# 4 (R4) did not have a written physician's order indicating the need for them, in their file. All other residents had proper written physician's orders for the bed rails in their files. The facility is required to have auditory devices. LPA Maldonado observed the auditory device in room# 3 to be inoperable. Cameras were observed operating in common areas of the home. No cameras were observed in private areas/resident rooms. (Report continued on LIC809-C...) Resident bathrooms were observed to have a shower, toilet, and wash basin. The showers accommodate non-ambulatory residents and have the required grab-bars and non-skid mats. The hot water was tested and measured at 126*F, which is not in compliance . The food supplies was observed and had the required 2-day perishables and 7-day non-perishables. Emergency food and water was also available. Fire extinguishers were observed throughout the facility, with current inspections and were fully charged. The first aid kit was observed to be complete and a current first aid manual was available. All sharps, cleaning supplies and toxins were observed locked and inaccessible to residents in care. A fire place was observed in the living room, covered by a screen and inaccessible. The smoke/carbon monoxide detectors were tested, were interconnected and operational at the time of the visit. A fish pond was observed in the back yard. It had water, but it is completely fenced off, inaccessible to residents in care. The last fire drill was conducted on 5/21/23, which is not in compliance. During the file review, it was discovered that Staff# 3's (S3) file was missing proof of the required annual training, and CPR/First Aid certification expired on 05/2020. The file for Staff# 2 (S2) was also missing a health screening. LPA also discovered that the Administrator did not have a complete file at the facility available to review/audit. After review of resident files, it was discovered that Residents# 1, 4 and 5 (R1, R4, and R5) do not have an updated medical assessment as they are required to, due to cognitive impairment. It was also discovered that (5) of (6) residents do not have an Appraisal/Needs and Services Plan on file. After review of resident medications, it was discovered that R2, R5, and R6 were missing medications that have not yet been refilled. It was also discovered that R2 and R4 had medications and vitamins that are being administered to them without physician's orders on file. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies were observed during today's visit and will be cited on the LIC809-D. Additionally, immediate civil penalties were assessed in the amount of $500, due to a Fire Clearance Violation. An exit interview was conducted with Administrator, Ralph Estanislao, and a copy of the report and appeal rights were provided and discussed.