Routine inspection·April 2, 2024

Licensing Program Analyst (LPA) V. Maldonado made an unannounced visit at the facility for the purpose of conducting the required annual inspection, using the Compliance and Regulatory Enforcement (CARE) Tool, to evaluate the facility. LPA Maldonado met with Licensee/Administrator, Humberto Santamaria, and explained the purpose for the visit. During today's visit, LPA Maldonado conducted a tour of the physical plant with Licensee, observed the facility food supplies, reviewed (6) resident medications, (6) resident files, (6) staff files, and conducted interviews with (2) staff, and attempted interviews with (6) residents. The facility is a single-story home, operating as a Residential Care Facility for the Elderly. It is licensed to serve (6) older adults, ages 60 and over. The fire clearance is approved for (6) non-ambulatory residents and has an approved Dementia Care Plan. Facility has an approved Hospice Waiver for (6) residents. There are currently (4) residents receiving hospice care. An approved mitigation plan is in place and Infection Control plan has been submitted to the department for review. The facility has an active and current liability insurance policy on file, as required. LPA observed all resident bedrooms to have the required furniture, sufficient lighting, and closet/storage space. There are (2) full bathrooms in the home- both equipped with required grab bars and non-skid mats. The hot water was tested and measured at 114*F, which is in compliance. Food supplies was observed and was sufficient as required. All sharps and cleaning supplies/toxins were observed to be locked and inaccessible to residents in care. Fire extinguishers were observed throughout, with current inspections and were fully charged. Smoke/Carbon Monoxide detectors were tested and observed operational, during the visit. The last fire drill was conducted on 01/14/2024. An auditory devices is installed and interconnected at the home. It was observed to operate for all entrances/exits of the home, as required. LPA observed several surveillance cameras in the front yard, back yard, and common areas inside the home. Per Licensee, the surveillance cameras have been installed and operational since they were first established in 2013, prior to the change in ownership and remained operation through the change in ownership. (Report Continued on LIC809-C...) LPA reviewed the Plan of Operation provided by Licensee for this facility and was unable to confirm the approval of use of surveillance cameras. Resident files were reviewed and observed to be complete with all the required documentation. Staff files were reviewed. (2) of (6) staff files were missing the required Health Screening. Resident medications were reviewed. Resident#5 (R5) had several stored medications that are being administered without written prescriptions on file, and one of the medication bottles was empty, requiring a refill. Per Licensee, R5's family is responsible for refilling and providing the documents to Licensee. However, after many attempts of speaking with the family to resolve the matter, Licensee has been unsuccessful with the medication requirements/needs from R5's family. Per California Code of Regulations, Title 22, Deficiencies were observed and will be cited on the LIC809-D. An exit interview was conducted and a copy of this report was provided.