Routine inspection·August 18, 2023

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. Caregiver Reyna Cecilio assisted with the visit. Administrator Robin Aquino was explained the purposed of the visit telephonically, but was not able to be present during the visit. There are currently 5 elderly residents 60 years and older and 1 under age 59 residing in the home. Four (4) residents are receiving hospice care, and two (2) residents receive home health care. The following 12 (CARE) tool domains were utilized during the inspection: Infection Control, Operational Requirements, Physical Plant/Environment Safety, Staffing, Personnel Records/Staff Training, Resident Records/Incident Reports, Planned Activities, Food Service, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. There is a visitor sign-in station located in the main entrance. The facility has and Infection Control Plan. Operational Requirements: The facility has a Dementia Waiver in place. A Hospice Waiver for 4 is approved. A fire clearance for 6 non-ambulatory adults 60 and over; of which one (1) may be bedridden in room #4 4 only. NOTE: Bedridden resident (R1) is residing in the fire clearance designated bedridden room #4. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place and expires 8/26/2023. Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood that is licensed for six (6) non- ambulatory residents, of which 1 may be bedridden. It consists of 4 bedrooms; 4 for residents [2 private & 2 shared) and 1 office, 2 bathrooms, living room, dining room, kitchen, outdoor patio area, laundry room, and a 2 car detached garage in the rear of the property presently being used as storage area. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Sharps and toxins were locked. The facility has two (2) fully charged fire extinguishers, a fire pull alarm, and fire sprinklers. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. Staffing: A total of 8 caregiver staff provide care and supervision to the clients. Personnel Records/Staff Training: Administrator certificates expires 11/14/2023. Personnel files/training were reviewed. Proof of staff training, health clear ance, criminal background clearance and 1st Aid/CPR training were verified. However, staff (S3) began working at the facility on 5/16/2023 and no staff training has been completed/documented on their file. Citation was issued. Resident Records/Incident Reports: A total of five (5) resident files were reviewed. Files contained admission agreements, Physician's Reports, Appraisals, TB clearance, COVID-19 vaccine cards, Functional Capability Assessment, and emergency information. RCFE complaint poster and Personal rights were observed posted in the dining area. ***narrative continues next page*** Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Indoor and outdoor activities are performed regularly. An activity calendar was posted. The facility does not have a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Physician orders for modified diets are in place for resident (R1). Sanitation practices and kitchen cleanliness was observed. Incident Medical and Dental: A 30-day supply of centrally stored medications was observed. Medical and dental transportation is provided by family members. Disaster Preparedness: Emergency and Disaster Plan LIC 610E is posted. The last emergency disaster drill was conducted on June 21, 2023. Residents with Special Health Needs: Four (4) residents are enrolled in hospice care and 2 residents receive home health services. Postural support physician orders are on file. Appraisals were observed in files. Half and full bed rails for mobility assistance were observed in resident beds. Resident (R1's) bed has full bed rails and is not enrolled in hospice. A citation was issued. No residents have prohibited health conditions. Per California Code of Regulations, Title 22, deficiencies were cited. Exit interview was conducted with caregiver Reyna Cecilio. A copy of the report and appeal rights were issued.