Routine inspection·October 12, 2024

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and was greeted by Percy (Caregiver) and the purpose for today’s visit was explained. Shortly after Assistant Administrator Liza Trice assisted with visit. The facility is licensed to serve 6 Non-Ambulatory residents ages 60 and above, with a hospice waiver for 2. The facility is a single story home located in Bellflower, Ca. A tour of the facility includes: living room, dining area, kitchen, 5 resident bedrooms (1 shared room), 1 staff bedroom, 4 bathrooms (1 staff, 1 visitor, 1 resident, 1 private in room 4), laundry room, detached garage, tool shed, front yard and back yard. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit todays visit and the initial visit and observed the following: Infection Control: There is sufficient PPE supplies and Infection Control Plan is maintained at the facility. Operational Requirements: The facility has an approved fire clearance, there is a plan of operation with required Infection Control Plan and facility maintains the required liability insurance. Physical Plant & Environment Safety: LPA toured facility, residents’ bedrooms were checked and closet/drawer space to accommodate each resident comfortably was available. The front yard is free of debris/hazards and the outdoor and passageways are free of obstruction. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available for clients. The hot water temperature was tested throughout the facility and measured within the required range of 105-120 degrees F. All storage areas for cleaning solutions, toxins, knives, and hazardous items are kept in a locked and are inaccessible to residents. Smoke detectors and carbon monoxide detectors are operable and in compliance. There fire extinguisher was observed and is fully charged. Staffing : There appears to be sufficient staffing at all times in the facility. With night staff that is trained and able to assist in care and supervision of the residents in the case of an emergency. (Continued on LIC809-C) Personnel Records-Training : Staff has criminal record clearance, current First-Aid/CPR/AED training along with training in postural supports, medication assistance, dementia, hospice and other ongoing training are documented in personnel files. LPA reviewed 5 staff files and observed Staff #3 to be missing their health screening and First-Aid certificate to be missing, citation issued and detailed on the LIC809-D. Administrators Thomas Trice and Liza Trice have valid certificates that expire in Dec. 2024. Resident Records-Incident Reports: Resident files are kept in a secure location and have the following documents in their files - Pre-admission appraisal/Appraisal Needs & Services Plan, Admission Agreements, Identification & Emergency Information and current Physician's Report. LPA reviewed 6 Resident Files with no issues observed. Residents Rights-Information: Residents are provided with telephone and internet at the facility. The facility has the following posters posted: Residents Rights, Complaint Poster, and Ombudsman. Planned Activities: Facility provides scheduled activities and have a variety of activities to choose from within the facility. There is an outdoor activity area available for the residents. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Incidental Medical & Dental: Medication is properly labeled and are centrally stored in a closet and are in their original containers. Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. Technical violation was issued as the fire drill record was not at the facility, per Assistant Administrator the log was taken to office to scan for record keeping as drill was conducted just last week, all previous logs for drills were documented only the current log was missing. Residents with Special Health Needs: There are no bedridden or residents with postural supports at this facility. Facility has the required "Oxygen in Use" signs posted. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit will be detailed on the LIC809-D. Exit interview held and a copy of the report and appeal rights were provided to Assistant Administrator Liza Trice.