Routine inspection·December 30, 2024

At approximately 9:45 AM, Licensing Program Analysts (LPAs) Julie Florio and Star Stevenson arrived unannounced to conduct a required 1-year annual inspection and were greeted by Staff. Designated Responsible Party (DRP), Frank Nola, was contacted and arrived at approximately 10:20 AM. Facility is a Residential Care Facility for the Elderly (RCFE) with 19 residents in care. Facility has a Dementia Care Plan, is approved for 11 non-ambulatory residents, bedridden residents on first floor only, and has a Hospice waiver for 5. Facility currently has one (1) Hospice resident in care. At approximately 10:40 AM, LPAs initiated a tour of the facility with DRP and observed the following: Facility is a two story converted convent, was a comfortable temperature, and passageways were free from obstructions. LPAs observed an evacuation chair at each stairwell for emergency prepairdness. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPAs observed a supply of clean linens, and hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPAs observed a menu posted throughout the facility, and facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency Food and water supply. However, LPAs observed at least three instances of expired food and several instances of unlabeled opened or unsealed food items throughout facility freezers and refrigerators, (see LIC809D). Medications were centrally stored and locked. There is a shaded seating area in the backyard with outdoor space for activities. LPAs observed two (2) locked sheds in the backyard which LPAs inspected and observed the contents to consist of PPE supplies, extra resident care equipment, holiday decorations, chemicals and tools. Continued on LIC809-C... Continued from LIC809C... LPAs observed an activity schedule and residents attending a live music session in the facility's activity room during inspection. LPAs observed games, activities, crafts, movies, musical instruments and more for residents in care. Facility has internet access and provides an internet access device for resident use. Facility has a telephone which was tested during inspection. Facility's fire extinguishers were observed charged and were last serviced 06/2024. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Centralized Fire system is inspected annually . Facility conducts bi-yearly disaster drills. However, Facility was unable to provide proof of completion on for any drills this year, (see LIC809D). Additionally, LPAs advised DRP that drills shall be conducted on a quarterly basis to bring the facility into compliance with regulation. LPAs observed the facility's infection control plan, first aid kit, PPE, and emergency supplies. LPAs reviewed facility's emergency disaster plan last updated 10/2024. At approximately 12:15 PM, LPAs conducted file review. Six (6) staff files and six (6) resident files were reviewed. All staff files reviewed have all of the required paperwork except Staff 1 (S1) was missing proof of negative TB results; S1, Staff 2 (S2), and Staff 3 (S3) were missing proof of at least 20 hours of required initial training; and S1, S2, S3, and Staff 4 (S4) were missing proof of the required 16 hours of medication training shadowing, (see LIC809Ds). All staff had proof of CPR and First Aid training. Six (6) of six (6) resident files reviewed contained the required documentation per regulation. However, Resident 1 (R1) was missing proof of negative TB results and a signed admissions agreement; Resident 2 (R2) was missing a consent for emergency medical treatment and a signed care plan; and Resident 3 (R3) and Resident 4 (R4) were both missing signed care plans as well, (see LIC809Ds). DRP states residents' families coordinate residents' medical and dental appointments and transportation to and from visits. Medications were reviewed and observed managed and maintained within regulation. However, LPAs observed at least one (1) medication not recorded into the resident's centrally stored medication record and other instances of medications being improperly recorded, (see LIC809D). continued on LIC809C... continued from LIC809C... Required Change of Administrator Documents: LIC 308 (Designation of Facility Responsibility) Active and Current Administrator Certificate First Aid Certificate LIC 500 (Personnel Report) LIC 501 (Personnel Record) LIC 503 (Health Screening Report - personnel) Proof of Negative TB test LIC 9182 (Criminal Record Exemption Transfer Request) LIC 508 (Criminal Record Statement) Copy of Driver's License or Passport that is not expired Copy of Board of Directors' Resolution meeting minutes signed (required for all corporations) Updated copies of the following documents are to be submitted to CCL within 30 days of this visit : Proof of Liability Insurance (updated) Proof of property ownership 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 with DRP and Appeal rights were given. Signature on form confirms receipt.