Routine inspection·January 30, 2024

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to caregiver Lilibeth Alcala. Administrator Laurie Gallegos arrived shortly after. The facility serves residents ages 59 and older. The following 12 (CARE) tool domains were utilized during the inspection: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. There is a visitor sign-in station located in the main entrance. The facility has an Infection Control Plan. Operational Requirements: A current Plan of Operation was reviewed. A Dementia waiver and hospice waiver for six (6) is in place. A fire clearance for 6 non-ambulatory adults 60 and over. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place and expires 2/1/2024. A surety bond is not applicable. Facility does not handle resident's money. "Narrative continues next page.**** Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood. It consists of 5 bedrooms; 4 for residents [2 private & 2 shared) and 1 staff bedroom in room #5, 2 1/2 bathrooms, living room, dining room, game room, kitchen, outdoor patio area, laundry room in bathroom, and a 2 car attached garage. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. There is an inoperable small water fountain and jacuzzi in the backyard. T he backyard cement walkway is cracked and lifted posing a tripping hazard. A citation was issued. The facility has two (2) fully charged fire extinguisher and a pull alarm Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. Staffing: A total of 4 caregiver staff provide care and supervision to the clients. Personnel Records/Staff Training: Administrator certificates expires 9/5/2024. Personnel files/training were reviewed. Proof of staff training, health clearance, criminal background clearance and 1st Aid/CPR training were verified. Resident Records/Incident Reports: A total of six (6) resident files were reviewed. Files contained admission agreements, Physician's Reports, Appraisals, TB clearance, Functional Capability Assessment, and emergency information. RCFE complaint poster and Personal rights were observed posted in the facility entrance area. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Indoor and outdoor activities are scheduled at least 3-4 times a week. The facility does not have a Resident Council. ***Narrative continues next page.*** Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Physician orders for modified diets are in place. Incident Medical and Dental: Centrally stored resident medications were observed to have a 30-day supply of medications. Resident (R1) had 1 medication and 2 supplement medications in an unlocked drawer in the room. The supplements do not have physician orders. Citation was issued. Medical and dental transportation is provided by family members. Disaster Preparedness: Emergency and Disaster Plan LIC 610E is in place. The last emergency disaster drill was conducted on 11/16/2023. Residents with Special Health Needs: One (1) resident is receiving home health services and one (1) resident is enrolled in hospice care. Postural support physician orders are on file. Half bed rails for mobility assistance were observed in resident beds. A full bed rail was also observed for the resident enrolled in hospice services. Individual Service Plans and Appraisals were not observed in resident files. No residents have prohibited health conditions. Per California Code of Regulations, Title 22, deficiencies were cited. Exit interview was conducted with Administrator Laurie Gallegos. A copy of the report and appeal rights were issued.