Routine inspection·April 5, 2024

Licensing Program Analysts (LPAs) Erik Zaragoza and Daniel Konishi conducted an unannounced Required 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA explained the purpose of the visit to Moris Shockley, President and CEO of Hollenbeck Palms, and was granted entrance. Administrator Diana Medina arrived shortly thereafter. There are one-hundred and sixty-two (162) residents currently living in the facility. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: · Infection control practices and Personal Protective Equipment (PPEs) were observed. Infection Control Plan will be submitted to LPA within seven (7) days. Physical Plant/Environment Safety: · The facility is a single-story home located in a residential neighborhood. It is licensed for a capacity of six (6) residents, all of which may be non-ambulatory, four (4) may be receiving hospice, and one (1) of which may be bedridden. It has four (4) resident rooms, a dining room which also contains the facility’s washing and drying machines, a kitchen, two (2) residents bathrooms of which Restroom #1 had a hot water temperature reading at 109.8 Degrees F and Restroom #2 had a hot water temperature reading of 107.1 Degrees F, a backyard patio which contained a shaded area for residents, and also a detached garage that functions as the facility’s storage and holds additional food and incontinence supplies. Cleaning supplies and chemicals are kept locked in a cabinet in the kitchen. · The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. The facility has two (2) fully charged fire extinguisher located on both floors of the facility, including the basement. There were no sharp objects that were left accessible to residents. · Water temperature readings measured between the required 105 - 120 degrees Fahrenheit. Operational Requirements: · The facility did not have a Plan of Operation on record, administrator was asked to provide this to LPA at a later date. · Fire clearance was approved by LA County Fire Department for a capacity of six (6) residents, all of which may be non-ambulatory, four (4) may be receiving hospice, and one (1) of which may be bedridden. · Care and supervision to meet the clients’ needs was observed. Staffing: · A total of seventeen (17) full-time staff members provide care and supervision to the clients. Personnel Records/Staff Training: · Five (5) staff files were reviewed for criminal background clearance and training. · Personnel records have health/TB screenings, CPI training, certifications, and 1st Aid/CPR training. Resident Rights/Information: · Physician orders were reviewed for four (4) resident files. · Medications were also reviewed for four (4) residents. Resident Records/Incident Reports: · Four (4) resident files were reviewed containing admission agreements, Physician's Report, medical/functional assessments, Needs and Services Plans, TB clearance, Appraisal/Needs and Services Plan, personal rights, medical consent, and medication records were reviewed. Food Service: · The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Incident Medical and Dental: · All residents have an Appraisal/Needs and Services Plan on file. · Staff training was on file. Disaster Preparedness: · Emergency and Disaster Plan was publicly posted and found within the facility. · An emergency and disaster drill was last documented in 2020. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809Ds. Exit interview held and a copy of the report along with appeal rights were provided.