Routine inspection·February 27, 2025

02/27/2025, Licensing Program Analyst (LPA) Loera conducted an unannounced Annual Required – 1 yr. inspection visit for this facility. Facility has an emergency disaster plan as required. Facility has an infection control plan as required. There are currently 25 residents in care. Facility approved/cleared for 49 non-ambulatory, of which 10 may be bedridden, and hospice waiver for 20. At approximately 10:20am, LPA and Administrator toured the building and grounds. The facility was found to be at a comfortable temperature. LPA observed a 2 day supply of perishable and 7 day supply of non-perishable food. Refrigerated food was found to be stored in a safe manner being labeled and dated. Facility has extra food and PPEs located in the garage/storage room. The main building is two stories. The second building is single story and currently there are three residents, LPA observed a staff member with a resident in the living room area . LPA observed an out of order sign for one of the two washer machines. Per conversation with administrator they have put in a work order for maintenance to come out and replace/fix it. LPA observed all exits doors to have working alarms. LPA observed 1 evacuation chair located around the corner from stairwell #1 but no evacuation chair at stairwell #2 that leads outside the building (Technical Violation Issued) . LPA suggested for facility to have a sign up on the wall indicating the location of the evacuation chair for stairwell #1. Department of Social Services will reach out to Fire Marshall's to discuss the placement of the evacuation chairs. LPA observed All rooms were equipped with lighting, night stand, and chest of drawers. All rooms were in good repair. Extra hygiene products and linens were available. Water temperature in sinks accessible to residents in care were measured at 110.6, 110.3, and 117.7 which is within the range of 105 to 120 degrees F. Fire extinguishers were last inspected 04/2024. Facility has fire sprinklers throughout. Toxins are stored in a locked laundry room. Medications were found to be centrally stored. LPA conducted spot medication count and found all prescription medication to be properly recorded on the Centrally Stored Medication Record. LPA conducted review of 5 staff records/training. Upon a review of staff records, LPA found 4 out of 5 staff (S1, S3, S4, S5) to be missing required annual and/or initial training (Deficiency Issued) . LPA observed S3 to be missing current 1st Aid & CPR certification on file. LPA conducted a review of 5 resident records. LPA observed 2 out of 5 residents (R1 and R2) to not have updated physicians report (Technical Violation Issued) . continued on LIC809-C Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 03/27/2025: LIC500- Personnel Report LIC308- Designation of Responsibility Infection Control Plan (review, update if needed) Emergency Disaster Plan (review, update if needed) Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and a copy of this report was provided .