Routine inspection·November 17, 2023

Licensing Program Analyst (LPA) V. Maldonado made an unannounced visit at the facility for the purpose of conducting the required annual inspection, using the Compliance and Regulatory Enforcement (CARE) Tool, to evaluate the facility. LPA Maldonado met with Caregiver, Tita Bartolata, and explained the purpose for the visit. During today's visit, LPA Maldonado conducted a tour of the physical plant with Caregiver, Tita, observed the facility food supplies, reviewed (3) resident medications, (3) resident files, (4) staff files, and conducted interviews with (2) staff and attempted interviews with (3) residents. The facility is a single-story home, operating as an Residential Care Facility for the Elderly. It is licensed to serve (6) older adults, ages 60 and over. It has an approved dementia care plan. There is a fire clearance approved for (6) non-ambulatory residents, of which (1) may be bedridden, and has a hospice waiver approved for (2). There are currently no residents receiving hospice services. An approved mitigation plan is in place and Infection Control plan has been submitted to the department for review. The facility does not have a current Liability Insurance Policy in place. Per the Licensee/Administrator, Teresita Maralit, the policy has expired and is in the process of applying for a new policy with a different company. The facility consists of (4) resident bedrooms, (1) live-in staff bedroom, (2) resident bathrooms, (1) staff/visitor bathroom, a living room, kitchen, dining room, TV room, shaded patio in the backyard and a detached garage. All resident bedrooms were toured and observed to have a smoke detector, the required furniture, linens, and sufficient closet and storage space. LPA observed the following in bedroom# 3: the smoke detector was opened and did not have batteries- inoperable, damage to the ceiling which appeared to be cracked and paint is chipping, and the wall to the right side of the entrance was scuffed and had paint scratched off. Bedroom# 2 was toured and LPA observed that the emergency exit leading to the outside was locked by key from the inside, which does not allow for quick exit in case of an emergency. LPA also observed the front entrance door locked by key, from the inside. The facility does not have a fire clearance approved for locked perimeters/exterior doors. (Report Continued on LIC809-C...) Per staff, they have been instructed to lock this door due to Resident# 3 (R3) wandering and staff afraid of R3 walking out of the facility. Staff unlocked and opened the door. LPA observed that the auditory device at the door was inoperable. Auditory devices at all other entrances/exits were also observed to be inoperable and one was missing at the sliding door in the TV room. Full bed rails were observed on Resident# 1's (R1) bed, without written physician's orders in R1's file, indicating the need for the bed rails. Per staff, R1 was recently discharged from Hospice but is still using the hospital bed. Resident bathrooms were observed to have a toilet, shower, and wash basin. The staff bathroom has a Jack & Jill hand wash sink and the sink to the left side was observed to have a sign indicating "Pls don't use this side. It's leaking. Thanks" LPA opened the faucet and observed water leaking from underneath the sink, into a small bucket. The resident bathrooms were observed to have the required non-skid mats and grab bars. The hot water was tested and measured between 140*F- 144*F. The hot water requirement is currently not being met. The kitchen was toured and all appliances were operating properly. There was a sufficient amount of perishable and non-perishable food in the kitchen refrigerator, the kitchen pantry, and the refrigerator in the garage. LPA observed the cabinets underneath the kitchen sink to be broken. There are pieces of wood placed on the floor holding the cabinet up, and the top of the cabinet is hanging down. Caregiver stated Licensee is aware of the broken cabinet. All sharps were observed to be stored and inaccessible in a drawer next to the kitchen sink. Cleaning supplies/toxins and laundry supplies are stored in a cabinet in the laundry room, inaccessible to residents. Several fire extinguishers were observed throughout the facility with recent inspections and were fully charged. LPA observed several cameras in the facility, located in the hallway and common areas only. The smoke/carbon monoxide detectors were tested and operational. After review of resident files, LPA discovered that files for (3) of (3) residents were missing Pre-Admissions Appraisals and Needs and Services Plans. Files for R2 and R3 were missing records for residents cash resources/personal property/valuables and Functional Capabilities Assessments. After review of staff files, it was discovered that (3) of (4) staff did not have a personnel file in the facility to review, which includes the Administrator/Licensee's file. LPA also discovered that (2) of (4) staff were not associated to the facility, but had proper criminal background clearance. LPA reviewed (3) residents' medications and observed them to be documented properly and given as prescribed. (Report Continued on LIC809-C...) During today's visit, LPA observed R3 attempting to open the front entrance door several times, attempting to walk away and wander off while staff were tending to other residents. LPA also observed visitors of other residents attempting to provide care/supervision to R3 during their visit, by calling R3 back every time R3 attempted to walk away and asking R3 to sit and stay there while caregivers were tending to the other residents. LPA determined that there is insufficient staff to care for residents with dementia and wandering behaviors. After speaking with Licensee/Administrator, she informed LPA that she is at the facility about 3-4 hours a day, 3-4 times per week to oversee the operations of the facility. Due to deficiencies cited today, repeat violations observed, LPA determined the administrator is not on the premises sufficient hours to permit adequate attention to the administration of the facility. Per California Code of Regulations, Title 22, deficiencies were observed and are cited on the attached LIC809-D. Additionally, Civil Penalties in the amount of $1,900.00 were assessed and issued during today's visit due to repeat violations within a 12-month period, as well as caregivers working at the facility without proper association to the facility, and violation of fire clearance. An exit interview was conducted and a copy of this report and appeal rights were provided to caregiver, Tita Bartolata. Licensee was also phoned, and citations and civil penalties were discussed.