Routine inspection·June 21, 2024

Licensing Program Analysts (LPA) Nune Margaryan conducted an unannounced annual visit using the Care Tool. LPA met with Administrator Linda Fan who assisted with visit. LPA explained the reason for the visit. The facility is licensed for residents age range 60 and over. Approved for 29 non-ambulatory residents of which 14 may be bedridden. Facility approved Hospice waiver for 10. There are currently 8 residents on hospice. The facility is a two story building. LPA and Administrator toured the facility which included: random selection of resident bedrooms on both floors, Reception area, common area / activity exercise area, Administrator office / Medication area, laundry room, dining area, kitchen, linen supply room, cleaning supplies room, two public bathrooms, rest area (TV and computer room), public bathroom but currently used it as storage. The facility also has a large back patio area. The passageways, walkways and patios are free from obstructions. The backyard patio area is well maintained and there are no pools or large bodies of water. The common areas are clean and have the required furniture. The resident bathrooms have the required grabs bars and non-skid mat. The water temperature was tested in a random selection of resident bathrooms and was measured within Title 22 Regulation guidelines. Resident bedrooms have the required furniture such as bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space. Resident beds have the required linen, and the linen is in good condition. At the time of inspection, LPA observed medication in the room #202, on bedside table. LPA observed that facility does not have "No smoking oxygen in use" signs posted on the residents’ rooms who are in hospice and use oxygen. Smoke/Carbon monoxide detectors observed throughout the facility and were operational. There are several fire extinguishers located throughout the facility and observed fully charged. Kitchen appliances are clean and were operating at the time of the visit. Continue 809C Sharps are locked in the kitchen and are inaccessible to residents. Food supply adequate stored in the kitchen, storage room and consists of the following: 2 days perishable but there's not enough food supply for 7 days non-perishable. Cleaning supplies and toxins were observed in the laundry room and supply room locked and inaccessible to residents. LPA reviewed 3 resident records to confirm emergency contact is updated, physician's reports are on file, and admission agreements are complete. Two staff records were reviewed to confirm health screenings, training, and fingerprint clearances. LPA reviewed 3 residents' medications. Medications are documented properly and given as prescribed. First Aid kit was fully stocked with current manual. Per California Code of Regulations, Title 22, the deficiencies observed are documented on the attached 809D. Exit interview held. A copy of the report and appeal rights were provided to Administrator