Routine inspection·June 16, 2024

Licensing Program Analyst (LPA) Kimberly Ramirez conducted required annual inspection. LPA met with Caregiver Priscilla Serna and explained the purpose of today’s visit. Care Manager Victora Serna arrived within the hour. This facility is licensed to serve six (6) residents over the age of 59, of which six (6) may be non-ambulatory; (1) may be bedridden. This facility may retain no more than six (6) hospice residents. There is one (1) resident under hospice care. LPA Ramirez observed four (4) staff providing care and supervision during inspection. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Physical Plant and Environment safety: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be accessible to residents in laundry room. LPA Ramirez observed disinfectants and cleaning solutions located in cabinet above washer and dryer, to be accessible to five (5) out of the six (6) residents. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected five (5) resident rooms. All resident bedrooms contained required furniture, linens and lighting. Water temperatures in all grooming and bathing areas were measured to be above 120 degrees F. Water temperature in bathroom#1 was measured at 124 degress F, bathroom#2- 122.2 degrees F, and bathroom#3- 123.6 degrees F. LPA Ramirez observe postings encouraging proper handwashing etiquette in restrooms. LPA Ramirez observed grab bars near toilets. LPA Ramirez will issue two (2) Type A deficiencies based on observations. Food Service: LPA Ramirez observed sufficient supply of nonperishable for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean and within temperatures of 0-degree F (-17.7 degree C), and refrigerators with maximum temperature of 40 degree F. (4 degree C). Planned Activities: LPA Ramirez observed sufficient space to accommodate indoor and outdoor activities. LPA Ramirez observed staff and resident engaging in cognitive abilities game during inspection. Residents Rights-Information: LPA Ramirez observed the following postings in common areas throughout the facility: Complaint Poster (PUB 475), personal rights, and nondiscrimination notice. LPA Ramirez observed facility land line. SEE 809-C for continuation. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D) in place. Last documented emergency drills were conducted on 05/24/2024. LPA Ramirez observed facility sketches with exits and emergency exits routes upon entrance of facility. LPA Ramirez observed emergency food supply in laundry room. Emergency water supply was located in garage. Residents with Special Needs: No large bodies of water were observed. LPA Ramirez observed signs posted indicating “No smoking - Oxygen in Use” was observed. LPA Ramirez observed several oxygen tanks in resident rooms secured in stands. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. Auditory devices were observed to be in working order. Health Related Services/Incidental Medical Services: Medications are centrally stored in medications cart and in bubble packs and/or original containers. The facility uses the Medication Administration Record (MAR) log to document medications given. The facility provides incidental medical services. Six (6) MAR records were compared to medications stored. Staffing: Administrator Certificate for Tony Santos and expires 02/19/2024. LPA Ramirez observed Administrator’s Certificate for Victoria Santos and expires 08/24/2025. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Personnel Records Training: Staff files are maintained at the facility. LPA Ramirez observed CPR and First Aid for four (4) out of the four (4) personnel records reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for four (4) out of the four (4) personnel records reviewed. LPA Ramirez did not observe required initial/annual training in personnel files. Care Manager Serna agreed to print completed training and place in personnel files. LPA Ramirez will issue Technical Violation. Infection Control: There are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place. Operational Requirements: The fire clearance is approved for six (6) non-ambulatory residents, of which one (1) may be bedridden. This facility may retain no more than six (6) hospice residents. There is one (1) resident under hospice care. Resident Records/Incident Reports: LPA reviewed Resident files for Resident #1 (R-1) through Resident #6 (R-6). Resident files are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent For Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, Resident Rights were observed. R5 did not have required annual medical assessment. LPA Ramirez will issue Type B deficiency based on record review. Three (3) deficiencies were observed during inspection. Exit interview was conducted. A copy of this report, 809-D and appeals rights was provided.