Routine inspection·September 26, 2023

License Program Analyst (LPA) Shannan Hansen arrived unannounced to conduct an Annual Required – 1 yr. visit of the facility. LPA was welcomed by Administrator Natalia Meyerson. There is a total of 8 residents with 4 residents currently on Hospice. LPA toured the facility on 9/26/2023 at 9:00 AM with administrator; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguisher was found to be last charged on 8/22/2023 at the time of the visit. Facility smoke detectors are hard wired and sound directly to the fire station. Smoke detectors and fire sprinklers are inspected annually. LPA is requesting a copy of annual smoke/alarm inspection. LPA observed Carbon monoxide detector that was found to be operational during the visit. Facility has a generator that will start if there is a power shut out. Hot water temperature measured between 109 degrees F and 113.5 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 3 of 3 resident’s bathrooms while touring facility on 9/26/2023 at 9:15 AM. Facility serves residents with dementia and has special care plan of operation and programming. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations at the time of the visit. Food is available for residents any time of the day. There are activities schedule for residents' weekly. Toxins are stored in locked bathroom cabinets & locked kitchen cabinet under sink. There was a supply of cleaners, hygiene products and paper products available for residents. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower. A sample tour of resident’s bedrooms was conducted, and bedrooms inspected have lighting & appropriate furnishing. Beds were outfitted with mattress pads as required by Title 22 Regulations # 87307 on 9/26/2023. Continue LIC 809-C A sample review of five resident & five staff records as well as two resident’s medications was conducted. LPA reviewed a random sample of resident’s files at 11:15 AM on 9/26/2023 and learned that 4 out of 5 residents have an updated reappraisal/needs & care plan on file (see LIC809D) & 5 out of 5 residents have updated medical assessments at this time as required by Title 22 Regulation. Medications were centrally stored in a locked medication cabinet in the facility medication room. The Medications of 2 out of 2 residents were found to be pre poured and records do not match medication counts per according to physicians’ directions on 9/26/2023 at 1:45 PM. Centrally Stored Medication Record (CSMR) of 2 out of 2 residents were found to be inaccurate (see LIC 809D). LPA conducted a sample reviewed of staff records at 1:15 PM on 9/26/2023 and learned that all facility staff and other individuals who require caregiver background checks have received criminal record clearances or exemptions. However, Direct care staff haven’t received the additional training requirements as per Title 22 Regulations and H&S Code (see LIC809D). LPA was presented with proof of CPR & 1 st Aid certification for staff; although 2 of 5 staff do not have required First Aid certification (see LIC809-D). Natalia Meyerson Administrator Certificate # 6016748740 expires on 5/17/2024. LPA reviewed Licensing Information System (LIS) with administrator who stated that is corrected and updated at this time; no need to change any of the information. In addition, LPA advised facility to check with the County regarding what is the County Emergency Plan; ensure that disaster drills are conducted in different shifts, and review facility emergency plan to ensure accuracy according to the needs of facility residents. Disaster Drills have been conducted with the last one being conducted on 8/21/2023. Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided. Continue LIC 809-C LPA Hansen is requesting Licensee to update and submit the following documents by 10/13/2023: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Copy of Administrator Certificate Copy of Control of Property (Deed or Lease) Copy of Certificate of Liability Insurance Copy of last Annual smoke/alarm inspection