Routine inspection·April 22, 2022

Licensing Program Analyst (LPA) Luis Mora conducted an unannounced annual visit at the facility with focus on the infection control domain, medication and food review. LPA Mora met with Caregiver Grace Aregbesola and explained the reason for the visit. The Administrator Lilian Ikpeamaeze showed up shortly after. The facility is licensed to serve 6 non-ambulatory residents age 60 and above of which 1 may be bedridden. Facility has a hospice waiver for 2 residents. The facility is located in a residential area. A tour of the single-story facility included: living room, kitchen, dining area, activity area, 4 resident bedrooms, 1 administrator office, 1 staff bathroom, 1 resident bathroom, and attached garage. LPA and Lilian Ikpeamaeze toured the facility and the following was observed: the front and backyard are well maintained. There is a shaded seating area for the residents located in the backyard. Passageways and exits are free of obstruction. Auditory devices were seen on exit doors which are required for dementia residents and were operating at the time of the visit. The water temperature was tested in both bathrooms and measured at 78.5 degrees F (residents bathroom) and 80.1 degrees F (staff bathroom) which is not within the required 105 - 120 degrees F. The bathrooms are clean and have the required grab bars in the shower and near the toilet for non-ambulatory residents. Showers also have non-skid materials. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have enough closet space. Resident beds have the required linen and the linen is in good condition. There is extra clean linen and towels in a hallway closet. Smoke detectors were observed in each room and throughout the facility and are properly operating. There is 1 carbon monoxide in the hallway and is properly operating. There are 2 fire extinguishers located in the kitchen and living room which are fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps, cleaning supplies and toxins are kept locked under the kitchen sink and are inaccessible to residents. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. First Aid kit was fully stocked with current manual and it is kept locked in the administrator office. Residents medication are centrally stored in locked cabinets in the kitchen. Residents and staff files are centrally stored in the administrator office. (CONTINUED TO LIC 809C) LPA reviewed all 6 resident files and observed that 3 out of 6 residents who are diagnosed with dementia do not have a current physician report. LPA reviewed 7 staff files and observed that 6 out of 7 staff did not have a health screening, and 6 out of 7 did not have a valid First Aid/CPR certificate. LPA reviewed medication for all 6 of the residents and observed that medications are documented properly and given as prescribed. LPA observed administrator certificate for Lilian Ikpeamaeze – 6049496740 with an expiration date of 08/26/2022. Facility is following COVID 19 recommendations regarding screening visitors, staff, and residents. Signs are posted throughout the facility, and hand-washing signs were observed in bathroom. Sufficient hand soap, hand sanitizer, and paper towels were observed. Supply of 30-day Personal Protective Equipment (PPE) was observed in the garage. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were deficiencies observed during the visit (refer to LIC 809D). Exit interview held and a copy of the report and appeal rights were provided.