Routine inspection·August 9, 2024

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the Required Annual Inspection. LPA was greeted and granted entry by facility administrator Nellie Mae Caudle after introducing himself and stating the reason of the visit. During the inspection, LPA and facility staff conducted a tour of the physical plant and observed the following: The facility is a one story home with four private bedrooms and one staff room in addition to the facility's common living areas and two bathrooms, one of which is en-suite. All resident bedrooms have the required furnishings. LPA observed all beds have linens and blankets. Postural supports observed in one room and physician orders verified to be on file. There are currently two residents admitted to the facility with one receiving hospice care. Residents are observed to be clean and appear well taken care of. Bathrooms faucets and toilets were operational. Water temperature was verified to be within acceptable range. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. Fire drills are conducted quarterly. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required. Smoke and carbon monoxide detectors tested operational. Fire extinguishers present are observed to be fully charged with up-to-date maintenance. Medication, sharp items and cleaning supplies were confirmed to be inaccessible throughout the physical plant. The medication central storage was also observed to be secure and reviewed for accuracy during the visit. LPA reviewed two resident files and two staff files. One resident and one staff interview were conducted during the visit. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 Based on staff records reviewed and interview with the administrator, it was confirmed that the cardio-pulmonary resuscitation training for both employees had lapsed and will need to be renewed. The facility's professional liability insurance is also stated to have lapsed and will need to be renewed. One admission agreement reviewed was found to be missing the resident's signature and was signed during the present visit. Based on the observations made during today’s inspection, two type B deficiencies and one technical assistance advisory note are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report along with appeal rights was left at the facility.