Post-licensing visit·August 22, 2024

Licensing Program Analyst (LPA) Jose Villalobos arrived unannounced to conduct an Post Licensing inspection. LPA met with staff Reina Rojas who allowed entry into the home. The purpose of the visit was discussed. Administrator Hyo Kim arrived shortly after. The Facility is licensed for six (6) residents who may be non-ambulatory, of which up to three (3) may be bedridden. Fire clearance for bedridden residents may be in Rooms #2-#4. Hospice Waiver approved for up to six (6) residents in care. Dementia care plan is in place. The inspection was completed using the CARE tools. Observations: LPA toured and inspected a total of (9) rooms. Bedrooms #1-#6 was used for residents #1-#7 (R1-R7), Resident #8 (R8) is using the living room as their bedroom, and staff room was being used for Residents #9-10 (R9-R10). The facility is operating over its licensed capacity. LPA continued tour and observed (2) rooms used as a staff office and staff supply/break room. There are (3) bathrooms, (1) dining room, (2) living rooms, backyard with locked detached garage, and a laundry area. Sharps were observed secured in locked. The facility was free of odor, clean and in good repair. No obstructions were noted in hallways or living areas. Sufficient furniture and lighting was observed throughout the facility. LPA reviewed plan of operation. personnel policies reviewed and discussed. Reporting requirements were discussed. This included abuse reporting procedures. (10) Resident file records were reviewed. Resident files all had admissions agreements but missing various other documents such as physicians reports and appraisals. Continued on LIC 809-C (4) Staff records were reviewed. (2) Files requested by LPA were unavailable as they had not been created by the administrator. Per Title 22, All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. LPA checked criminal record clearances and staff #1 (S1) is not cleared or associated to this facility. Centrally stored medications were reviewed. LPA observed R3, R7, and R8 to have medication out in common areas. Medications observed were also popped out and prepared into weekly boxes. In-service training's and medication procedures were not logged. See Something Say Something complaint poster, Evacuation Routes and facility license were all posted as required. Deficiencies noted and citations issued per the California Code of Regulations, Title 22, Division 6, Chapter 8, which includes immediate civil penalties. Please see the attached LIC 809D. Immediate Civil Penalty was assessed. Per Title 22, Division 6 ,Chapter 8 (f) Violation of Section 87355(e) shall result in an immediate assessment of civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days by the department. Civil Penalties were assess at $300 for this violation. Additionally, immediate civil penalties were assessed in the amount of $500, due to a Fire Clearance Violation. Exit interview conducted. Appeal rights were discussed with Administrator Hyo Kim. A copy of the report and appeal rights were provided.