Inspector’s narrative
What the inspector wrote
Licensing Program Analyst (LPA) V. Maldonado made an unannounced visit at the facility for the purpose of conducting the required annual inspection, using the Care Compliance and Regulatory Enforcement (CARE) Tool, to evaluate the facility. LPA met with Caregiver, Rosalyne Obedoza and explained the purpose for the visit. Administrator, Shelly Yamashiro, arrived shortly after and assisted with the visit.
The facility is licensed to serve (6) elderly adults, ages 60 and over. It is approved for (6) non-ambulatory residents, of which (1) may be bedridden in room#4 only, and has a Hospice Waiver approved for (3). The facility is a single-story home, located in a residential area. The home consists of a living room, (4) residents bedrooms, (2) resident bathrooms, a kitchen, dining room, attached garage, and shaded patio with seating in the backyard.
The following (12) CARE tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Client Rights/Information, Client Records/Incident Reports, Food Service, Health Related Services, Incident Medical and Dental, Disaster Preparedness, and Emergency Intervention. During today's visit, LPA Maldonado obtained a copy of the resident and staff roster, and conducted a tour of the physical plant with assistance of Caregiver, Rosalyne. The following was observed:
There is one central entry point for universal entry screening. The facility has an Infection Control Plan approved and in place. There is sufficient PPE stored for 30-days and readily available for use, throughout the home and stored in the hallway closet. The physical plant inside and out is clean, sanitary and in good repair. All walkways, pathways, and ramps were observed to be free of obstruction/hazards. All resident rooms were inspected and observed to have the required furniture, bedding, linens, chair, adequate lighting, and closet space. At 9:20AM, LPA observed (2) resident beds to have full bed rails and (1) resident bed had half bed-rails. (
Report Continued on LIC809-C...)
Resident files were reviewed and observed to have written orders indicating the need for the bed rails in place. Each restroom was equipped with a toilet, shower, and wash basin. The restrooms had the required grab bars and non-skid mats/strips. Additional linens and towels for residents were stored in a hallway closet- inspected and observed to be in good repair. All kitchen and laundry equipment was observed clean and operational during today's visit. The water was tested and measured at 112.6*F in bathroom# 1 and 111.3*F in bathroom# 2, which is in compliance. The facility food was inspected and was observed to be sufficient for the amount of residents in care. The requirement was met for 2-day perishables and 7-day non-perishables available. Emergency disaster plan, facility license, personal rights, and complaint procedures are posted as required. The smoke and carbon monoxide detectors were tested and observed to operate properly. Fire extinguishers were observed in the kitchen and in the hallway, with current inspections and were noted to be fully charged. There is a working telephone in the facility for residents to use. No bodies of water were located on the premises. There is adequate seating in common areas for the licensed capacity. Cleaning supplies/toxins were observed stored and locked under the kitchen sink and in the garage, inaccessible to residents. Each entry/exit was equipped with auditory devices and operational. Sharps were observed stored in a kitchen cabinet, locked and inaccessible to residents
At 9:45AM, LPA observed a room built inside the garage that appeared to be new. The room was equipped with (2) beds, a closet, and there was clothing, shoes, and other personal items there. Per Caregiver Rosalyne, she and another staff live at the home and occupy that room. Per Administrator Shelly, the property is leased and is unsure if the Lessors obtained proper permits to build the room. She was unable to provide any proof and it is not indicated in the facility sketch or Pre-Licensing report that the facility was licensed with that room. (4) Resident files were reviewed and observed to be complete with, but not limited to: current health screenings, appraisals, admission's agreements, personal rights, and emergency contact information. (5) Staff files were reviewed and were complete with/but not limited to- fingerprint clearances, health screenings, and proof of required annual training. At 12:15PM, (4) Resident medications were reviewed and observed to not have accurate records for centrally stored prescription medications for 4 residents, and there was no record of dosages for several centrally stored medications for Resident# 4 (R4). Interviews were conducted with (2) staff and attempted with (3) residents, as (1) was out in the community, and the others were busy at the time of the visit.
Per California Code of Regulations, Title 22, deficiencies were observed during today's visit and will be cited on the LIC809-D.
An exit interview was conducted with Caregiver, Rosalyne Obedoza, and a copy of the report and appeal rights were provided.
