Routine inspection·February 1, 2024

Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection on 2/1/24. LPA arrived unannounced and met with Staff, Theresa Kuwashima. The purpose of the visit was explained. Administrator, Silvia Castro, arrived shortly after to assist with the visit. The facility is licensed for 6 non-ambulatory residents, ages 60 and over, of which 1 may be bedridden. There is a hospice waiver approved for 3 residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tool to inspect the facility and the following were observed: Infection Control: The facility staff are performing hand hygiene and wearing gloves when necessary to assist residents. Staff are cleaning and disinfecting daily and following the infection control plan. Administrator provides annual training on infection control. Operational Requirements: The facility has a dementia care plan to accept or retain residents with dementia. There are currently 5 non-ambulatory and 1 ambulatory resident residing at the facility. The facility maintains sufficient liability insurance to cover injury to residents and guests. Physical Plant & Environment Safety: The facility is a one-story house that consists of 4 resident bedrooms, 1 communal bathroom, 1 staff room with private bathroom, living room, kitchen, dining area, laundry area, and attached garage. Cleaning supplies are locked in the closet and inaccessible to residents. The facility has smoke detectors in each room and 1 carbon monoxide detector in the hallway by the front door. The fireplace is adequately screened. There are no pools or bodies of water on the premises and no items obstructing the walkway. Staffing : There is sufficient staffing at the facility. Staff employed have fingerprint clearance and associated to the facility. Personnel Records-Training : Staff files are maintained at the facility. LPA reviewed 3 staff files. They have current CPR/first aid training and sufficient on-going training that meets the annual requirement. Staff #2 did not have the TB test result nor chest x-ray on file. Resident Records-Incident Reports: Resident files are maintained at the facility and have the following documents in their files - Admission Agreements, Identification & Emergency Information, Physician's Report, Consent forms, Resident rights, Safeguards for Property/Valuables form. Resident Rights-Information: The Complaint poster, Local Ombudsman, and Residents personal rights are posted. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical/mental capability. Staff encourage residents to participate in activities. Food Service: There are sufficient food supplies of 2-day perishable and a week of non-perishable items. The kitchen is clean and free of rodents or insects. Incidental Medical & Dental: The medications are centrally stored and in their original bubble packs. The facility uses the Medication Administration Record (MAR) log to document medications given. LPA reviewed all 6 residents' medications and they are being administered as prescribed by the physician. Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites. They conduct different types of disaster drills and are documented with the date, time, and participants. Residents with Special Health Needs: The facility accepts and retains residents with dementia and/or hospice. The staff receive the appropriate number of hours annually to care for residents with dementia. LPA interviewed 2 Staff and a resident during the visit. A deficiency is issued on the LIC809D. An exit interview was held. A copy of this report and appeal rights were given to the administrator.