Routine inspection·November 8, 2024

Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection on 11/8/24. LPA arrived unannounced and met with the Executive Director, Christina Matsumoto. The facility is licensed to serve 120 non-ambulatory residents, ages 60 and over, of which 10 may be bedridden. Rooms #129 - #145 and all first floor rooms (except for rooms #101, #103, #105, #107, #109, and #111) are approved for bedridden. The 3 exterior gates are approved for delayed egress. There is a hospice waiver for 20 residents. LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tools. The facility is a 2 story building with resident rooms on both floors. The main floor consists of the main lobby, dining room, kitchen, resident rooms, and the memory care unit. The 2nd floor consists mainly of resident rooms and activity rooms. There is no swimming pool on the premises. LPA selected 8 random rooms (#112, #141, #143, #156, #215, #225, #226, and #238) to inspect. The rooms have non-skid mats and the hot water temperature was measured within range of 105-120 degrees F. There are multiple carbon monoxide detectors in each hallway. The fireplace is adequately screened. Facility has sufficient space to accommodate indoor and outdoor activities. There are planned activities daily . There are sufficient food supplies of 2-day perishable and a week of non-perishable items as well as water supply. The foods are properly stored in the refrigerator. The facility has a dementia care plan to accept or retain residents with dementia. Residents utilizing oxygen tanks have signs posted at the front door. Facility is continuing to follow their infection control plan and using appropriate hand hygiene. Gloves are worn by staff while assisting residents with some of the activities of daily living. The liability insurance is still current for the coverage of $1 million (per occurrence) and $3 million (total annual aggregate). Per the administrator, there is sufficient staffing for each shift. There is at least one staff with CPR & First Aid training on each shift. LPA reviewed 5 personnel files. The Administrator's certificate expires on 7/25/25. The staff files have the required documents and have fingerprint clearance. Staff are receiving the appropriate training for dementia care. LPA reviewed 8 resident files. The files contain the admission agreement, medical assessment with TB results, consent forms, property valuable form, and pre-appraisal form. Medications are centrally stored in a locked cart in the med room. The medications were checked for 6 out of the 8 residents and there were no discrepancies found. Information for appropriate reporting agencies are posted at the facility. The facility has the updated Emergency Disaster Plan and is receiving unannounced fire drills/disaster drills training from a specialist for all shifts. There were no deficiencies issued today. An exit interview was held and a copy of this report was given to Administrator Matsumoto.