Post-licensing visit·January 29, 2024

Licensing Program Analyst (LPA) V. Maldonado made an unannounced visit at the facility for the purpose of conducting the required Post-Licensing inspection, using the Compliance and Regulatory Enforcement (CARE) Tool, to evaluate the facility. LPA Maldonado met with Licensee/Administrator, Humberto Santamaria, and explained the purpose for the visit. During today's visit, LPA Maldonado conducted a tour of the physical plant with Licensee, observed the facility food supplies, reviewed (3) resident medications, (3) resident files, (3) staff files, and conducted interviews with (2) staff, and attempted interviews with (3) residents. The facility is a single-story home, operating as a Residential Care Facility for the Elderly. It is licensed to serve (6) older adults, ages 60 and over. There is a fire clearance approved for (6) non-ambulatory residents. It has an approved Dementia Care Plan and a Hospice Waiver approved for (6) residents. There are currently no residents receiving hospice services. An Infection Control plan has been submitted to the department for review. The facility has an active and current liability insurance policy on file. Upon entry, LPA Maldonado observed a video screen on the kitchen counter with audio, projecting a live video feed of Resident#2's (R2) room with R2 and their visitors in the room. LPA inquired with Licensee on the surveillance camera, who stated that R2's family brought it and requested it be used to keep view of R2 due to R2 wandering at night. Licensee stated however, that they have not had any issues with R2 wandering or getting up at night since admission to the facility. LPA observed all resident bedrooms to have the required furniture, sufficient lighting, and closet/storage space. LPA observed full bed rails on Resident#1-2's beds, which have written orders from the use of them. The resident bathroom is equipped with required grab bars and non-skid mats. The hot water was tested and measured at 119*F, which is in compliance. Food supplies was observed and was sufficient as required. There are no bodies of water on the premises. Fire extinguishers were observed throughout, with current inspections and were fully charged. All sharps and cleaning supplies/toxins were observed to be locked and inaccessible to residents. (Report Continued on LIC809-D...) Smoke/carbon monoxide detectors were observed in each room- last fire drill conducted on 1/08/24. Auditory devices were observed at all entrances/exits of the home and operational. (3) resident files and (3) staff files were reviewed. (3) Resident files were observed to be missing signatures by residents or their responsible parties on Physician's Reports, Appraisal/Needs and Services Plans, Resident Inventory documents, and Consent for Emergency Medical Treatment forms were incomplete. (1) Resident file was missing a Pre-Placement Appraisal. (1) Staff file was observed to be missing a Health Screening, and (2) staff records were missing training records. At 3:00PM, LPA reviewed (3) resident medications, and discovered records for Centrally Stored Medications to be missing for several medications. LPA could not determine that all medications are given as prescribed. Per California Code of Regulations, Title 22, citations will be cited on the LIC809-D page. An exit interview was conducted and a copy of this report and appeal rights were provided.