Routine inspection·April 8, 2025

Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced annual inspection visit. LPA met with facility director, Hardie Lin and Licensee, Amber Branconier arrived a short time later. The purpose of today's visit was discussed. The facility has a capacity of 120 residents. It is licensed to serve elderly residents aged 60 and above, approved for 120 non-ambulatory residents of which 21 may be bedridden. The facility has five (5) Hospice Waiver on file. Annual licensing fees are current. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: 1. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. 2. Operational Requirement: Liability Insurance is updated and in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place. 3. Physical Plant and Environmental Safety: The facility is located in a residential area. It is a two-story building with 60 resident rooms. Facility consists of Lobby/Reception Area, office, medication room, Activity Room, TV/Entertainment Room, Beauty Shop, Employee Room with lockers and time clock, laundry room, kitchen, and dining room. Residents' medications are centrally stored and locked in the medication room. LPA Lopez inspected ten (10) residents’ rooms. Resident bedrooms had most furniture, lighting fixture and personal storage space as required. Mattress pads were observed on all beds. Bathrooms inspected were clean, operable, and furnished with the required grab bars and some rooms were missing non-skid materials in the shower. Hot water temperature was in a range of 112.2 – 123.4 degrees Fahrenheit which is not within Title 22 Regulation guidelines. (Continue on 809C) All the cleaning supplies and chemicals are stored and locked in a cabinet in the laundry room area The linen and towels are stored in housekeeping closet The extra personal hygiene products are stored in the locked closet upstairs. The carbon monoxide detectors were inspected, and they are working properly. The facility has table and chairs for resident to utilize outdoor activity. The Passageway, walkway and patio are free of obstruction. 4. Staffing: The facility has sufficient staffing, and the night supervision staff have current CPR/first aid certification. 5. Personnel Record-Training: All the staff files are maintained in the facility. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. All the direct care staff did not have ongoing Medication Management and other required Training. However, training certificates were not in their files. 6. Resident Records-Incident Reports: Resident files are maintained at the facility and have the following documents in their files - Admission Agreements, Identification & Emergency Information, Pre-admission appraisal/Appraisal Needs & Services Plan. 7. Resident Rights-Information: The Complaint, ombudsman and CCLD poster and Residents personal rights are posted by the main entry. Visiting hours are included in admission agreement. 8. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. 9. 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 very clean and sanitary. The food is properly stored in the refrigerator (clean, labeled and well maintained). Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents. 10. Incidental Medical and Dental: The medication is centrally stored and locked in the medication cabinet in the hallway. Five (5) centrally stored resident medications were reviewed, which contained 30-day supply of medications. One resident (R5) was out of one medication and had not been administer for at least 1 week. Disaster preparedness: The last fire drill was conducted on 03/27/2025. The facility has an Emergency Disaster Plan (LIC610E) that needs to be updated. The facility has three alternative temporary shelter locations. 12. Resident with Special Health Needs: 48 residents are receiving home health services. No resident is currently on postural support. Individual Service Plans and Appraisals are on file. Deficiencies observed during today’s visit. Technical Advisory provided. An exit interview was held. A copy of this report, and appeal rights were provided.