Routine inspection·August 20, 2024

Licensing Program Analyst (LPA) Galarza conducted an unannounced annual inspection visit. The purpose of the visit was explained to Assistant Administrator Belen Taico. The facility serves elderly residents ages 60 and older. A hospice and Dementia waiver is in place. The facility is located in a residential neighborhood that consists of 4 resident rooms, 2 bathrooms, dining room/ living room, office, laundry room, medication/storage room, outdoor patio area, and detached garage. The inspection was completed using the CARE tools. Twelve (12) CARE tools domains were reviewed. The following were observed/inspected: Infection Control: The Infection Control Plan was reviewed. The facility has a supply of Personal Protective Equipment (PPEs). Operational Requirements: A hospice waiver for 4 residents is in place. A fire clearance for (6) non-ambulatory adults 60 and over; of which one (1) may be bedridden in room 4 only. Facility does not handle resident P & I monies. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current with an expiration date of 8/26/2024. Physical Plant/Environment Safety: 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. Cleaning supplies and toxic substances are inaccessible to residents. The facility has (3) fully charged fire extinguishers. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. Facility has a fire pull-alarm in the dining area. Staffing: A total of 5 staff members provide care and supervision to the clients. Personnel Records/Staff Training: Administrator certificate expires 11/14/2025. Staff have criminal background clearance and training. Five (5) staff files were reviewed. Proof of staff training, health and TB clearance, and 1st Aid/CPR training are on file. Resident Records/Incident Reports: A total of three (3) resident files were reviewed. They contained admission agreements, Physician's Reports, Appraisals, TB clearance, Physician's Orders, medical consent. Centrally stored medication records are in place. Facility does not utilize Medication Administration Records. RCFE complaint poster and Personal rights were observed posted. However, the RCFE Poster is 8 x 10, instead of 20 x 26 inches. A technical advisory was issued. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. 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. One resident has a modified diet plan. Incident Medical and Dental: Six (6) centrally stored resident medications were reviewed; containing a 30-day supply of medications. Medical and dental transportation is provided by family. Disaster Preparedness: Emergency and Disaster Plan LIC 610E was reviewed. Facility has a First Aid Kit and Manual. The last emergency disaster drill was conducted on 6/21/2024. Residents with Special Health Needs: Three (3) residents are receiving hospice services and zero (0) resident receive home health services. All 3 residents have a Dementia diagnosis. Full bed rails for mobility assistance were observed in hospice resident's rooms. No residents have prohibited health conditions. Per California Code of Regulations, Title 22, deficiencies were cited. Exit interview was conducted with Assistant Administrator Belen Taico. A copy of the report and appeal rights was issued.