Routine inspection·July 15, 2023

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 07/15/2023 at 9:25am. LPA was met by Staff #1 (S1) and explained the purpose of the visit. Facility is licensed to serve residents over 60 years old. The facility cares for elderly residents with dementia and is allowed to care for six (6) hospice residents. LPA OBSERVATIONS: Tour began at 9:55am and was led by S1. The facility is a single-story building located in a residential area with five (5) client bedrooms, one (1) staff bedroom, two (2) bathrooms, kitchen, dining room, living room, TV room, staff office, front yard, backyard, and attached garage. Front Yard: Was clean and well maintained. No hazards were observed. Kitchen: LPA Ramirez observed Staff #3(S3) providing meal assistance to Resident #6 (R6) at the dining room table. LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located in kitchen cabinet, to be inaccessible to six (6) out of six (6) residents in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located in kitchen cabinet to be inaccessible to six (6) out of six (6) residents in care. Kitchen sink water temperature was measured at 105.9 degrees F. Kitchen appliances were observed to be clean and in working order. Dining Room/Living room: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed to have plenty of seating and lighting. LPA Ramirez observed fully charged fire extinguisher in this area. Linen Closet: Contained plenty linens, towels, and hygiene products. SEE 809-C for continuation... Resident Rooms 1 - 5: LPA Ramirez observed all resident bedrooms to contain the required linens, furnishings, and lighting. LPA Ramirez observed required auditory devices to sound when resident patio door is opened. Resident rooms appeared to be clean. Bathrooms: Signs promoting hand washing were observed. Water temperature in resident bathroom#1 was measured at 109.4 degrees F which is in the required 105 – 120 degrees F. Bathroom #2 was observed to be clean and water temperature was measured at 113.2 degrees F which is in the required 105 – 120 degrees F. Grab bars were observed near toilets and in walk-in showers, in all bathrooms. Centrally Stored Medications: LPA observed cabinet located in staff office to be locked and inaccessible to residents in care. Backyard: LPA observed plenty of seating and shade. No large bodies of water were observed. LPA Ramirez observed several discarded wheelchairs and rubbish to be pilled on the side of outdoor pathway leading to the side of the facility. Emergency Drills: Proof of last documented fire drill was conducted 5/30/23. Carbon Monoxide Detectors/Fire Alarm/Fire Extinguisher & Emergency Disaster Plan: LPA observed carbon monoxide in hallways. LPA Ramirez observed posted Emergency Disaster Plan. Staff Personnel Files: Staff files are maintained at facility however; staff present at the facility could not gain access and licensee instructed staff to break in file cabinet. Five (5) staff files (S1 – S5) were reviewed. LPA Ramirez reviewed current First Aid/CPR certification, Health Screening and Tuberculosis Screening on file, Criminal record clearance, initial training and annual training. LPA Ramirez could not verify criminal clearance and health screening for S3. LPA Ramirez could verify S1 and S2 completed required annual training of postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. Resident Files: Six (6) resident files were reviewed. Admissions agreements and resident personal rights were observed in files. Liability Insurance & Infection Control Plan: LPA Ramirez reviewed and obtained a copy Infection Control Plan. Licensee provided LPA Ramirez with a copy of liability insurance. Deficiencies are being cited during visit. Exit interview was conducted S1 and a copy of this report, 809-D, LIC 9102, LIC 421BG and appeals rights were provided.