Routine inspection·January 26, 2024

At approximately 9:00 AM Licensing Program Analyst (LPA) Helena Rummonds arrived unannounced to conduct an annual required inspection and met with Administrator, Nancy Morquecho. LPA and Administrator discussed the purpose of the visit. LPA and Administrator initiated a tour of the facility around 9:15 AM and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Water temperature in sinks accessible to residents measured at 112, 107, 113, 112, and 118 degrees F which are within the range of 105 to 120 degrees F allowed per regulation. Extra hygiene products and linens were available. Cleaning supplies were stored in closet in kitchen, separate from food storage. Facility has at least two days of perishable and one week of non-perishable foods which appeared to be of quality and stored per regulation. Medications were centrally stored. LPA observed the medication room door to be open leaving medications accessible to residents in care. Administrator immediately closed and locked the medication room door. Emergency food and water supplies are rotated to keep them from expiring, and are stored in the facility kitchen. Personal Protective Equipment is stored in an outdoor storage shed. Fire extinguishers were last serviced November 2023. Facility has combination Smoke/ Carbon Monoxide detectors and a sprinkler system which was last inspected by the fire department on 12/13/2023. Most recent fire/disaster drill was conducted on 11/10/2021. LPA confirmed with Administrator that drills are to be conducted on a quarterly basis, as per Title 22 regulations. Continued on LIC809-C Continued from LIC809 5 staff files and 5 resident files were reviewed. Staff have required First Aid and CPR certificates. Training records were reviewed. Administrator Certificate for Co-Administrator, Rachel Hylton (6038480740), is up to date and expires 03/03/2024. Medications and medication records were reviewed. LPA observed medications to be pre-poured up to one day ahead. LPA had a conversation with Administrator and Med Tech on duty reminding them that medications are to remain in the original container in which the medication was received in until administration. Per conversation with Administrator, there are currently 8 residents in the facility who are bedridden. Facility currently has a fire clearance for 0 bedridden residents. LPA is requesting the following to update the facility fire clearance: -Updated facility sketch indicating which bedrooms are for bedridden residents -Updated LIC200 requesting bedridden fire clearance in section 1b LPA is requesting the following documents to be submitted to CCL by 02/26/2024: LIC 500 Personnel Report Liability Insurance LIC 9020 Resident Roster LIC308 Designation of Facility Responsibility Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC 809D, Appeal Rights, discussed and provided to Administrator. Signature on form confirms receipt of documents.