Routine inspection·September 21, 2023

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE tool. LPA met with Gina Lopez and explained the reason for the visit. The facility is licensed to serve 116 non-ambulatory and 104 bedridden residents over the age of 60 years old. Facility is a two story building with delay egress system at the main entrance, a lobby, a memory care unit, several common areas indoor and outdoor such as: a library, activity rooms, game room, private dining room, large dining room, 88 resident bedrooms with private bathrooms, shower rooms in the first floor and second floor, and a commercial kitchen. LPA toured the facility with Gina Lopez and Brianna Goodlet and observed the following: No large bodies of water were observed. A total of 10 resident rooms were observed with sufficient lighting, furniture and bedding supplies. Bathrooms were observed in working condition, with grab bars, and skid strips/mats. Toilet in room #149 was clog and overflowed when flushed. Water temperature was tested in each bathroom's sink and tested between 107.2 - 117.8 degrees F., which is within the required 105-120 degrees F. Dementia unit has a working delay system in each exit door. Ceiling outside the family lounge has a crack of about 14 inches in length and a water mark of about 15x15 inches in width. Disinfecting spray was observed in the dining/kitchenette area in the cabinets without a lock. The faucet's sink (no water) is out of order in the bathroom located in same dining room, bathroom is accessible to residents. Refrigerator in the activity area was observed dirty with spills and water drip tray has water build up as thick as almost 2cm. The dementia patio was observed with a screen door laying on the floor in between sitting area and a 3x2 feet bench was observed in a passage way to an exit door. 3x2ft chairs were observed in passage way outside room #119. Commercial kitchen was observed with different refrigerators/freezers and a walking refrigerator and freezer. Sufficient food was observed for at least 2 days worth of perishables and 7 days of non-perishables. Library was observed upstairs with a cover fireplace. All common rooms for activities were furnished with sufficient lighting. (CONTINUED ON LIC 809C) Evacuation chairs were observed at the bottom of each stairway. Fire extinguishers were observed and last checked on 9/7/23. Carbon Monoxide/Smoke detectors were observed throughout the facility along with a fire sprinkler system. Last fire-emergency drill was provided on 5/24/23. Emergency Disaster Plan was last updated on 9/1/23 on LIC 610E(10/03), which is not LPA Flores reviewed medication for 9 residents, 5 resident and 5 staff files. Resident #3(R3) has a dementia diagnosed and last physician's report is dated: 3/15/22. Staff #4 and #5(S4-S5) did not have a health screening on file and S4 did not have a TB clearance. First Aid/CPR training was not observed during staff file review. Administrator's First Aid/CPR training expired on 3/23. Administrator Certificate was observed for Brianna Goodlett #6057760740 expiration date: 11/4/22. No pending application was observed in our database. Per Brianna Goodlett a renewal for administrator certificate was not submitted and executive director Erin Mahoney is to be appointed as the new administrator. Licensee is to submit all required documentation within 10 days from this visit. Deficiencies are noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Gina Lopez and a copy of this report, LIC 809D, and appeal rights were provided.