Routine inspection·May 23, 2024

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit. The purpose of the visit was explained to caregiver staff Feiby Angeli Estanislao . Administrator Briana McGee arrived shortly after. There are currently 6 elderly residents 60 years and older residing in the facility. The following 12 Care Compliance and Regulatory Enforcement (CARE) tool domains were utilized during the inspection. Infection Control: The facility has an Infection Control Plan. Supplies of Personal Protective Equipment (PPEs) were observed. A visitor sign-in sheet is in place. Operational Requirements: An Infection Control Plan has been added to the Plan of Operation. The facility has a Dementia Waiver in place and an approved Hospice Waiver for 6 residents. A fire clearance for 6 non-ambulatory residents in bedrooms #1 - #3. Bedroom #4 is for staff use only. Liability Insurance in the amount of ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current with an expiration date of 6/27/2024. An American Red Cross 1st Aid kit and manual are readily available. No Surety bond is in place. Facility does not handle resident monies. *Narrative continues next page. Physical Plant/Environment Safety: The facility is a single-story home located in a residential area consisting of four (4) bedrooms, two (2) full bathrooms, kitchen, dining room, living room, laundry room, rear shaded patio area, backyard basketball court, and detached garage. The facility has one (1) fully charged fire extinguisher. Smoke and carbon monoxide detectors are operational. 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 were observed in the unlocked laundry room and the cabinet underneath the kitchen sink has a locking mechanism that is easily accessible to residents in care. Water temperature readings did not measure within the required 105 - 120 degrees Fahrenheit. Residents (R1 & R2) had 1/2 bed rails without a physician order, and R3 had full bed rails without being enrolled in hospice. Resident (R1's) medications were observed unlocked on top of the side dresser. Roommate has Dementia. Staffing: A total of four (4) staff members provide care and supervision to the clients. Personnel Records/Staff Training: Administrator certificate expired 11/19/2023. Recertification is pending approval. Four (4) staff files were reviewed. Proof of staff training, health clearance, 1st Aid/CPR training, and criminal background clearance was reviewed. Resident Records/Incident Reports: A total of six (6)resident files were reviewed. They contained admission agreements, Physician's Reports, TB clearance, Physician's Orders, medical consent, and medication records. None of the resident files had Appraisal Needs/Services Plans, and R1-R3 did not have physician orders for bed rails. RCFE complaint poster and Personal rights are posted. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Activities are individualized. 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. Three (3) residents have a physician order for a modified diet. Incident Medical and Dental: Three (3) centrally stored resident medications were reviewed to verify there is a 30-day supply of medications. Resident (R1) had unlocked medications in their room. Medical and dental transportation is provided by families. Disaster Preparedness: An Emergency and Disaster Plan is place. Disaster drill logs were not provided because they are off site. Residents with Special Health Needs: Two (2) residents are receiving hospice services. One (1) resident receives home health services. Postural support physician orders were not observed in all resident files. Full and half bed rails for mobility assistance were observed in all resident rooms; however residents (R1-R3) need physician's orders. No residents have prohibited health conditions. Appraisals are on file. Per California Code of Regulations, Title 22, deficiencies were cited. Exit interview was conducted with Briana McGee. A copy of the report and appeal rights will be emailed due to printing difficulties.