Routine inspection·September 2, 2022

Licensing Program Analyst (LPA) V. Maldonado made an unannounced required annual inspection at the facility. LPA Maldonado met with caregiver Santos Valencia and explained the purpose for the visit. Administrator Rafael Diaz was called and was also explained to purpose for the visit. LPA used the infection control tool to evaluate the facility. During today's visit, LPA toured the physical plant with caregiver Santos, observed the food and PPE supplies, and reviewed COVID-19 procedures, resident's medications and files, and staff files. The facility has submitted a mitigation plan and approved on 04/20/2021. The facility is a home located in a residential area. It is licensed to serve six (6) non-ambulatory residents, of ages 60 and over, of which one (1) may be bedridden. The facility has dementia care for residents and an approved hospice waiver for 2 residents. The facility has secured perimeters in the form of a motorized gate in the front to prevent residents from leaving the property. The home consists of five (5) resident bedrooms, one (1) which is a shared room, 2 bathrooms, a kitchen, dining room, office area, living room, shaded patio, and attached garage. During the visit, 6 residents in care were observed and 2 staff working. LPA toured the facility with caregiver Santos and observed the facility's food supply to have a variety of nutritious foods and was more than the required 2 day perishables, 7 day non-perishables, and emergency supplies. At 9:37 a.m., LPA observed a kitchen knife on top of the counter next to the kitchen sink. The staff stated they just finished preparing breakfast for the residents and put the knife away immediately. All resident bedrooms were observed to have the required bed linens, furniture, and sufficient lighting. Bathroom (RR)# 1 and # 2 had a working toilet, wash basin, and shower that accommodates non-ambulatory residents. At 9:45 a.m., room# 3 was observed to have cleaning supplies left out on the floor near the entrance. (Report Continued on LIC809-C...) At 9:56 a.m., the water temperature was tested and measured at 144.2*F in RR#1 and 141.4*F in RR#2. The RR's were also observed to be missing the required non-skid mats. Staff state regular bath towels are used in lieu of non-skid mats/strips as the facility is not equipped with any mats. All sinks were observed to be fully stocked with hand soap and paper towels for hand washing. Sufficient PPE was observed in the garage and in residents rooms. Laundry appliances were located in the garage and were observed to be operating and in good repair. All walkways and entrances/exits were observed to be free of debris and hazards. A fire extinguisher was observed in the kitchen to be fully charged. The smoke/carbon monoxide detectors were tested during the visit and were observed to be operational. At 10:26 a.m., LPA reviewed (5) of (6) resident files to confirm emergency contacts are updated. LPA also reviewed (2) staff files to confirm health screenings and fingerprint clearances. LPA reviewed (6) residents' medications. (4) of (6) resident files did not have complete files or updated emergency contacts. (1) of (6) resident files were not available to review at the facility, during the time of the visit. (1) of (2) staff files did not have health screenings or fingerprint clearance. No written orders were found for (2) residents' medications, and (3) residents had medications in their medication box that are not currently listed on their medication list. (1) resident with dementia did not have an updated Physician's Report. Per California Code of Regulations, Title 22, deficiencies were observed during today's visit and will be cited on the LIC809-D. Additionally, immediate civil penalties in the amount of $500 will be issued today. An exit interview was conducted with administrator Rafael Diaz over the phone and a copy of this report and appeal rights were provided to staff Santos Valencia.