Routine inspection·April 5, 2024

Licensing Program Analysts (LPAs) Bennette Pena and Daniel Konishi conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPAs met with Assistant Administrator, Alexander Solori o and the purpose of the visit was explained. There are currently eighty three (83) elderly residents 60 years and older residing in the facility. Facility is licensed to care for elderly residents age range 60 and over, 97 non-ambulatory, of which 30 may be bedridden. Hospice waiver for 30. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed.  There is a visitor sign-in station located in the main entrance lobby. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. Facility has Covid-19 signage posted throughout the facility including notification at the front door of exposure to Covid-19 if an individual visits the facility. Staff are adhering to infection control requirements. Operational Requirements: A current Plan of Operation was reviewed. The In fection Control Plan has been added to the Plan. Hospice Waiver for 30 is approved. A fire clearance is in place. Fire Drill was last conducted on 3/27/2024. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place and expires 04/01/2025. Surety bond in the amount of $10,000 is current. Physical Plant/Environment Safety: The facility is a single story building which consist of reception area, large dining area, forty nine (49) resident bedrooms, administration office, medication room, kitchen, storage room, cooler, electrical room, conference room and outdoor seating/smoking areas. 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. Cleaning supplies and toxic substances are inaccessible to residents. LPAs tested hot water temperature in eight (8) random rooms. Water temperature readings in Room #s 11, 33 and 34 did not measure within the required 105 - 120 degrees Fahrenheit. Rm #4 - 111.5 deg F Rm #11 - 124.5 deg F - 2nd reading 113.9 deg F Rm #14 - 109.2 deg F Rm #24 - 113.1 deg F Rm #33 - 134.9 deg F - 2nd reading 132 deg F Rm #34 - 131.3 deg F Rm #38 - 114.6 deg F Rm #45 - 113.5 deg F *****CONTINUED ON LIC809-C**** Staffing: A total of twenty five (25) staff members including the Administrator provide care and supervision to the residents. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have training and associated to the facility. Personnel Records/Staff Training: LPA reviewed eight (8) staff files and confirmed health screenings and fingerprint clearances. Proof of staff training, health clearance, vaccinations and 1st Aid/CPR training are current. Administrator Kandice Vergara's certificate expired on 3/15/2024. Assistant Administrator submitted the renewal on 2/14/2022 and has not received his certificate. Resident Rights-Information: Resident personal rights are posted. Notice of visiting policy is posted. Per Administrator, facility provides internet services to all residents and have access to the fac ility phone. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. LPAs observed that the activities calendar posted near the dining room was not up-to-date. The facility has a Resident Council. Facility provides equipment and space to accommodate both outdoor and indoor activities. Food Service:  Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Sanitation practices and kitchen cleanliness was observed. Kitchen staff workers were observed to be wearing hair nets and disposable gloves while working. Incidental Medical and Dental : Nine (9) centrally stored resident medications were reviewed; containing 30-day supply of medications. Medical and dental transportation is provided. Resident Records/Incident Reports: Resident files are maintained at the facility. A total of eight (8) resident files were reviewed. They contained admission agreements, Physician's Reports, Appraisal, TB clearance, Functional Capability Assessment, Physician's Orders, medical consent, medication records, and P & I money records. RCFE complaint poster and Personal rights were observed posted in the hallway near the dining area. The Incident report binder was reviewed. Disaster Preparedness: Emergency and Disaster Plan LIC 610E is in place . Records of resident Appraisal and Needs services plans are part of Emergency training. Residents with Special Health Needs: Currently, eleven (11) residents receive hospice care and seven (7) bedridden residents. Half bed rails for mobility assistance were observed in some resident beds.  Functional Capability and Preplacement Appraisals are on file. "Oxygen In Use" signs were posted on the resident doors who are using oxygen. Deficiencies issued on LIC809-D. An exit interview was conducted, and a copy of this report was provided to Alexander Solorio, Assistant Administrator along with the Appeals Rights.