Routine inspection·September 19, 2023

A t approximately 9:40PM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1-Year Required Visit and met with Staff Member, Yazmin Ovilla. Adminstrator, Justine Herrera, arrived during visit at approximately 9:55AM. Facility serves residents with dementia and has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance for 5 non-ambulatory and 1 bedridden resident for a total capacity of 6 residents. Facility has an approved hospice waiver for 3 individuals. Upon arrival, LPA was informed that there were 6 Residents in care and 2 staff on-site. At approximately 9:50AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 10:00AM, LPA conducted a walk-though of the facility with Administrator. LPA observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility is a 1 story building with 6 Resident bedrooms, 2 bathrooms, and common spaces. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for Residents. Mattress pads were in place or available for Resident use. During walk-through, LPA observed Lysol Disinfectant Spray located in a resident's bathroom. Facility staff immediately removed the disinfectant and locked it inaccessible to Residents in Care (This deficiency has been cited, see LIC809D, Regulation 87309(a)) LPA also observed that hot water temperatures for 2 of 4 sinks in facility were out of Title 22 regulations of 105 to 120 degrees Fahrenheit, measuring at 121.3F and 120.7F (This deficiency has been cited, see LIC809D, Regulation 87303(e)(2)). LPA also observed that the facility's main kitchen had a magnetic lock. Per conversation with Administrator, the lock was put in place during COVID-19 to prevent residents from over-eating at night time. LPA informed Administrator that a waiver request needs to be submitted to the Department for review and approval if they wish to have a locked fridge. Administrator stated that they will remove the lock since it is no longer necessary. Administrator stated that they understood if they wanted to have a lock on the fridge in the future, than a waiver request and its supporting documents would need to be submitted to the Department. LPA observed Administrator remove the magnetic lock from the main fridge during visit. Continued on LIC809C Continued from LIC809 At approximately 10:50AM, LPA reviewed staff files, resident files and resident medications. All Files were all found to be well organized, thorough and contained the required documentation. Staff files had current First Aid and CPR certification. Facility's fire extinguishers were found to be last inspected August 2023. Facility smoke detectors and carbon monoxide detectors were tested and operational. Facility's last emergency drill was conducted January 2023 (See Technical Violation, LIC9102, Health and Safety Code 1569.695(c) ). LPA is requesting the following documents to update facility file: Designation of Facility Responsibility (LIC 308) Emergency Disaster Plan (LIC 610D) Updated Personnel Report (LIC 500) Register of Clients/Residents (LIC 9020) Updated Liability Insurance Active and Current Administrator Certificate Facility Documents to be submitted to Community Care Licensing (CCL) by due date of Thursday, 10/19/2023. 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 (Deficiency Page), LIC9102 (Technical Advisory/Violation), Plan of Corrections, and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.