Routine inspection·December 31, 2024

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by facility caregiving after introducing himself and stating the purpose of the visit. Facility administrator Liezl Deocampo was notified by telephone and could not physically be present. There are currently four residents in care, two of which are receiving hospice care. Facility hospice waiver capacity is for one resident only. Citation issued. LPA observed residents relaxing in the facility’s common area or in their respective bedrooms. LPA accompanied by facility staff toured the physical plant. The facility is a one-story house with an attached garage. The facility has four bedrooms with two bathroom for residents Additional staff dwelling are located in the house as well as in an Additional Dwelling Unit which is not accessible to residents. Bedrooms appeared clean and sanitary. Full bed rails present in three bedrooms, orders reviewed. LPA observed all the resident bedrooms have the required furnishings. Bathrooms appear clean and sanitary. Bathrooms are equipped with grab bars and slip mats. Hot water temperature measured at 117F. LPA observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. LPA observed two knives locked in an unsecure drawer while the others are in the locked cabinet. Citation issued. A fire extinguisher is verified to be charged and mounted to the wall. LPA tested the smoke and carbon monoxide detectors which were found to be operational. The centrally stored medication is located in a locked cabinet in the hallway. The attached garage is inaccessible to residents and is used for storage. Cleaning supplies are stored partially under the unsecure kitchen sink and in the secure cabinet. Citation issued. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 LPA and facility staff toured the outside of the facility and observed it to be currently inaccessible and under construction. The main route of egress is however unaffected. Consultation provided. LPAs observed an shaded outdoor seating areas with furniture for resident use. The perimeter gates on one side of the property is self-latching and can easily be opened in an evacuation. There is a koi pond which will require to be secure once access to the backyard is restored. Consultation provided. LPA reviewed four resident records which included all necessary components. Two physician reports for dementia residents are however out of date. LPA reviewed resident medication records. Prescription orders verified for all four residents. LPA reviewed two staff records which were found to be complete. Training and CPR/First aid training reviewed and up-to-date. All staff are background cleared and associated to the licensed location accurately. There is no Infection Control and Emergency and Disaster plans need to be updated. Consultation provided. Based on the observations made during today’s visit, five deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Multiple consultations provided. An exit interview was conducted and a copy of this report along with appeal rights were provided to a facility representative.