Routine inspection·October 12, 2023

At approximately 9:15AM, Licensing Program Analysts (LPAs) Felias and Rummonds arrived unannounced to conduct a Required 1-Year visit and met with Administrator, Cleda Odiwe. Facility serves residents with dementia and has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance and capacity for 10 non-ambulatory residents. Facility has an approved hospice waiver for 2 individuals. Upon arrival, LPAs were informed that there were currently 8 residents in care and 3 staff members on-site. At approximately 9:30AM, LPAs 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 9:45AM, LPAs conducted a walk-though of the facility and observed the following: Facility is a 1 story building with 6 Resident bedrooms, 2 bathrooms, and common spaces. Facility had emergency lighting. 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. Hot water temperatures for all sinks in facility were within Title 22 regulations of 105 to 120 degrees Fahrenheit. LPAs observed a structure on the property not identified on facility's sketch. Investigation of the structure indicated that it is a two room structure. LPAs observed that one room is for storage, and the other is a living unit. Per conversation with Administrator, they sleep there when they decide to spend the night at the facility and the structure has been there since the facility was opened in 2001 (pictures of structure taken). During walk-through, LPAs observed the following deficiencies: Cleaning products and supplies located in residents' bathroom were unlocked and accessible to residents in care. Knives and other sharps were unlocked in a drawer accessible to residents in care (These deficiencies have been cited, see LIC809D, Regulation 87705(f)(1) and Regulation 87705(f)(2)). Three facility exits were obstructed by resident belongings in 2 of 6 bedrooms, and in the living room. LPAs saw a night stand and lamp obstructing the exit sliding door in Bedroom 1, a night stand, lamp, and dresser obstructing the exit sliding door in Bedroom 5, and a resident's walker obstructing the exit door to the backyard in the living room (This deficiency has been cited, see LIC809D, Regulation 87202(a)), and LIC421IM). Continued on LIC809C Continued from LIC809 LPAs saw expired food cans and yogurt, moldy sausages, and unlabelled and uncovered meals in fridge. Facility staff immediately discarded expired and moldy food (This deficiency has been cited, see LIC809D, Regulation 87555(b)(8)). LPAs observed feces and a soiled disposable pad in a resident's bedroom. The bedroom also had a strong smell of urine. During visit, LPAs observed facility staff clean the bedroom and replace the bed pad. LPAs observed that there was no longer a smell of urine. LPAs observed a pile of discarded items including wood, nails, caulk, and cardboard located on the side of the facility. LPAs also saw mold located on the exterior of the house, wood rot on the roof, facility's living room ceiling was observed to be caving in and the tiles in Bathroom 1 were moldy and were in need of replacing. LPAs saw that the bottom bathroom tiles were shown to be broken and peeling off from the wall (pictures of disrepair and items to be discarded taken) (This deficiency has been cited, see LIC809D, Regulation 87303(a)). LPAs unable to complete Required 1-Year/Annual visit. Annual Continuation Visit to be conducted at a later date. 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. ***An immediate civil penalty in the total amount of $500.00 has been issued for being out of compliance with fire clearance regulation 87202(a). Exit interview conducted. Copy of report, LIC809D, LIC421IM, Plan of Corrections, and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.