Routine inspection·June 2, 2023

Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. Upon arriving at the facility, LPA met with Administrator / Jennifer Leon who assisted with the visit. LPA explained the purpose of this visit. The facility is licensed to serve for a capacity of six (6) Residents ages 60 and over. The facility has an approved fire clearance for five non-ambulatory residents and one bedridden resident, designated to room #4. Hospice care waiver approved for six (6) residents. Currently, there are six (6) residents in placement. There is one (1) bedridden resident and four (4) residents receiving hospice services. The facility has an approved Dementia Care plan as part of its plan of operation and accepts/cares for residents with dementia. The following (CARE) tool domains were observed and reviewed during today's visit: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Food Service and Health Related Services. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility is encouraging hand washing and self symptom check of staff and visitors. Each client bedroom is designated as a COVID-19 isolation room if needed and will use the closest restroom. Physical Plant/Environment Safety: The facility is a single story home located in a residential area which consist of 2 living rooms, a kitchen, dining room, 5 resident bedrooms, 2 staff bedrooms, 2 bathrooms, a sun room/office, an attached garage/laundry area/storage and a backyard. No large bodies of water were observed. 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. Smoke and carbon monoxide detectors are operational. The facility has one (1) fully charged fire extinguisher. Cleaning supplies and toxic substances are inaccessible to clients. Water temperature readings were measured between the required 105 - 120 degrees Fahrenheit. The attached garage is kept locked and inaccessible to residents at all times. The facility has a Fire pull alarm located in the living room (near the main entrance). The exit gate located on the left side of the property facing the street is not enclosed by a fence with self-closing latches and gates, or walls, to protect the safety of residents. The self closing mechanism/latch on the exit gate located on the right side of the property facing the street, is inoperable and does not self close. The auditory chimes located on the exit doors in rooms 2 and 6 were observed to be inoperable. Operational Requirements: The Program Design was reviewed. Fire clearance was approved by LA County Fire Department for five non-ambulatory residents and one bedridden resident, designated to room #4. Care and supervision to meet the clients needs was observed. No Surety bond is in place. Facility does not handle resident monies. During today's visit, LPA was unable to verify the coverages listed on the Liability of Insurance as the facility renewed the policy effective 6/1/23 and a copy of a current Certificate of Liability Insurance has not been provided by the insurance carrier to the facility. LPA spoke with Licensing Program Manager Tony Vasallo, and was advised to obtain the renewal paperwork so that LPA Cynthia Chan can follow up with the Administrator. The Administrator was asked to provide a current copy of the Certificate of Liability Insurance to CCL within one week (6/9/23). No deficiency is issued today, per LPM Tony Vasallo. Staffing: A total of ten staff members provide care and supervision to the clients. Food Service: The kitchen was inspected and has sufficient supply of 2 day perishable & 7 day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Health Related Services: Clients are assisted with self administration of prescription and non-prescription medications. A random selection of resident medication records were reviewed. Centrally stored medications are kept in the closet located in the living room area (near the entrance door) and kept locked and inaccessible to residents in care. During today's visit, LPA observed a discrepancy on the labels listed on two bottles of the same medications and the instructions listed on the Medication Administration Record (MAR) for Carbidopa-Levodopa 25/100mg for Resident 1 (R1). Bottle 1 of Carbidopa-Levodopa 25-100 Tab states, take 2 tablets by mouth 5 times daily. Bottle 2 of Carbidopa-Levodopa 25/100mg states, take 2 1/2 tablets by mouth 5 times daily. According to the Medication Administration Record states, staff are administering the medication by administering "3 tabs PO QID" (four times daily). During today's visit, LPA observed an empty bottle of FOCUS CBD 25MG CBD gummies (chew 1 gummy PO QD (take once a day) for R1 and a new bottle with a refill was not available at the facility. Per California Code of Regulations, Title 22, deficiencies were cited. An exit interview was conducted and a copy of this report was provided to the Administrator.