Routine inspection·March 14, 2025

License Program Analysts (LPA) Luis De Leon conducted an unannounced annual required visit. LPAs met with Esther Araiza. Ms. Araiza called Administrator to inform of LPA visit. Administrator was not available at the time but requested Julie Hunter to help during visit. The purpose of today’s visit was explained to facility personnel met during this visit. Administrator Facility is licensed to serve six (6) non-ambulatory residents aged 60 and above of which 1 may be bedridden. Facility has a hospice waiver for 4 residents. Administrator. Administrator arrived and participated in visit. The LPA use the Compliance & Regulatory Enforcement Tool (CARE) during today’s inspection. The visit consisted as follows: FACILITY PHYSICAL PLANT · Three (4) resident bedrooms, two (2) Full Bathroom, attached car garage, shaded outdoor area, living room, kitchen, and dining room, and front and back yard. REVIEW OF FILES · Resident Admission Agreements, Residents & Staff files, Staff fingerprint clearance, Medications, Staff First Aid Certificate, Consumer Needs and Service Plan. · LPA reviewed three (5) staff files and four (5) Resident files. Interview was conducted with two (2) staff and one (1) Resident. Other residents were sleeping or unable to respond to questions. Continue on page 809C. Observations during facility tour: · Bedrooms were furnished with a bedframe, dresser, lamps, and chairs. LPAs observed that there was clean linen, bath towels, and personal hygiene with reasonable closet space available for residents. · Wall and floors are in good repair. Hallways were clean and free of obstructions. · Kitchen appliances were in working order and clean. There is sufficient two (2) days of perishables and seven (7) day supply of non-perishable food. · Auditory devices were seen on exit doors which are required for dementia residents and were operating at the time of the visit. · Toilets, showers, and water faucets are found in compliance with Title 22 regulations for temperature and function. Restrooms were stocked and clean. · The water temperature was tested and measured. It was found in compliance with Title 22 regulations between 105º and 120º F degrees. · Sharps are locked in kitchen and inaccessible to residents. Also, disinfectants and cleaning supplies are locked and secured inaccessible to residents. · Smoke detectors were observed in all bedrooms and carbon monoxide detectors was observed in living room around kitchen area. One (2) fire extinguishers were observed and were fully charged with last inspection on 7/23/24. · Last fire drill and disaster drill was conducted on 1/17/25. · Front and back yards are free of hazards and there were no bodies of water present at facility. Shaded area was available to residents. · The medications are centrally stored and locked in a cabinet in kitchen. The facility uses the Medication Administration Record (MAR) log to document medications given. LPA reviewed medications for all six (5) residents. Resident 1 (R1) had PRN prescription (Furosemide 20 mg) was given to resident but there was no documentation. In addition, two medications (Docusate Sodium 250 mg and Ferrous Sulfate 325 mg) had not been refilled. Resident 2 (R2) did not have medication on refilled (Memantine HCL 10mg, Vitamin D3 50 mg, Donepezil 5m). Resident 3 (R3) did not received medication as prescribed (Melatonin 5 mg). Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809D pages. Exit interview held and a copy of the report along with appeal rights were provided.