Routine inspection·April 9, 2024

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced required-1 year visit. LPA met with Marebeth Mallare, Administrator and explained the reason for the visit. The facility cares for residents age range 60 and over. The facility is licensed for (5) non ambulatory, (1) bedridden resident (shall be in bedroom #3), and approved for (6) hospice residents only. There are currently (3) residents on hospice. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: 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. Staff are trained on the emergency infection control plan and following hand hygiene techniques. Emergency and disaster plan was completed and up to date. Operational Requirements: A current Plan of Operation was reviewed. The Infection Control Plan has been added to the Plan. A Hospice Waiver for (6) is approved. Liability insurance policy expired on 03/01/2024 and the Administrator has not renewed the policy. The facility does not handle cash resources for the residents. Latest fire drill was conducted on 03/12/2024. Physical Plant/Environment Safety: The facility is a single story home located in a residential community. The home consists of living room, dining area, kitchen, (4) resident bedrooms, one of the bedrooms has a fireplace that is adequately screened, (4) bathrooms, back yard with swimming pool that is fenced and inaccessible to residents, and laundry area in the attached garage. The interior and exterior physical plant was inspected. Resident bedrooms were toured. Each bedroom has a smoke detector, bed, linen, dresser, light, and sufficient closet space. Bathrooms have the required grabs bars and non-skid materials. At 9:55am, LPA tested hot water temperature which measured at 108.6 deg F in bathroom #1, 110.4 deg F in bathroom #2, 112.4 deg F in bathroom #3 and 105.4 deg F in bathroom #4 which is within the required 105-120 degrees. Resident #3 (R3) and Resident #4 (R4) are both on hospice and observed to have full-length bed rails. Resident #2 is also on hospice and observed to have half bed rail. The resident in room #1 has 3 small dogs that are free to roams around the house. One resident e njoyed talking to and holding the dog. The laundry room is clean and has cleaning supplies inaccessible to residents. The kitchen was inspected. There is sufficient perishable and non-perishable food. All the appliances are cleaning and are working properly. The common areas such as activity room and dining room are clean and have the required furniture. The backyard has a shaded area and sitting area. There is also a swimming pool in the backyard Exit doors have auditory devices that were operating at the time of the visit. There are cameras in the front door, backyard, living room, dining area and kitchen. There were no cameras seen in private areas. Exit doors are free of any obstruction. Cleaning supplies and toxic substances are inaccessible to residents. The facility has four (4) fully charged fire extinguishers, last serviced on 01/13/2024. *****CONTINUED ON LIC809-C***** Staffing: A total of three (3) caregivers including the Administrator provide care and supervision to the residents. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have the required training and associated to the facility. Personnel Records-Training: Three (3) staff files were reviewed for criminal background clearance and training. Personnel records have health/TB screenings. Administrator has completed the required Administrator courses but has not submitted the certification renewal. Resident Rights-Information: Resident personal rights are posted. Visiting policy is not posted at a location that is visible and accessible to residents and families. Physician orders for use of full/half bed rails were reviewed in residents files. LPA conducted (2) resident interviews. Planned Activities: Information regarding Dementia is part of training for direct care staff and is included in the Plan of Operation. 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 clean and sanitary. The food is properly stored in the refrigerator (clean and well maintained). Two (2) residents have a special soft diet residing at this facility. Pesticides and cleaning supplies are kept away from the food preparation areas. Plates, cups and utensils are kept cleaned and stored properly. Incident Medical and Dental: All residents have Restricted Health Care Plan and Needs and Services Plan on file. Home Health personnel services the residents in the facility. Hospice and Home Health Nurses administer oxygen to the residents. Resident Records-Incident Reports: Four (4) resident files were reviewed containing admission agreements, Physician's Report, Medical/Functional assessments, Needs and Services Plans, TB clearance, Personal rights, Medical Consent, Medication Records, Restricted Health Care Plans and Hospice Records. Administrator did not have a current and complete medication record for all the residents for the month of April 2024. Disaster Preparedness: The facility has a complete Emergency Disaster and Mass Casualty Plan containing emergency evacuation, storage and preservation of medications, operation of manual assist devices. The facility conducts emergency drill on a quarterly basis for all staff and residents. Residents with SHN: (3) Residents on hospice requiring oxygen on as need basis but the facility did not have "No smoking-oxygen in use" signs posted on their rooms . Administrator has not reported to the local fire department that oxygen is in use at the facility. Administrator cannot provide proof of staff training on knowledge and use of the oxygen equipment. Per California Code of Regulations, Title 22, deficiencies were cited and Technical Assistance were issued. Exit interview conducted with Administrator Marebeth Mallare. A copy of the report and appeal rights were issued.