Routine inspection·August 19, 2023

On 08/19/23, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met administrators Jose Umana and Elsa Roman and explained the purpose of today’s visit. The facility is licensed to operate for (6) non-ambulatory, of which (1) may be bedridden elderly adults ages 60 and above. Currently, the facility has (1) hospice resident in care. The facility is approved for (2) hospice resident. The facility is a single-story structure located in a residential neighborhood. It consists of the following: (4) residents' rooms, (2) bathrooms, a living area, a dining area, a kitchen, an outside seating area, and a garage utilized for storage. LPA toured the physical plant. There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the resident's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 114.8 degrees F. A comfortable temperature of 75 degrees F. was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Fire extinguishers were charged. A review of the Medication Records Administration (MAR) was observed to be maintained in order and complete. (Evaluation Report continues LIC 809-C) During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on 07/14/23. The facility had operational smoke and carbon monoxide in bedrooms and common areas. The facility has current liability insurance on file effective 02/01/23 through 02/01/24. An audit of resident #1-#6 (R1-R6) service files and staff #1-#6 (S1-S6) personnel files. Interviews were conducted with (5) residents and (2) staff. The facility has the current administrator's certification on file for Elsa Roman #6040880740 Expiration 06/23/24. The facility is not current on (CCL) license dues and an invoice was provided. DEFICIENCY : Records revealed resident #1(R1) diagnsosed with dementia does not have a current medical assessment and appraisal. The last medical/appraisal is dated 04/08/21 and 04/14/21. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the following deficiencies has been observed and citation issued (ref. LIC 9099-D). An exit interview conducted with Jose Umana and a copy of report and appeal rights provided. Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) are cleared. *