Routine inspection·December 31, 2024

Licensing Program Analysts (LPAs) Hanna Gough, Nancy Guillen and Licensing Program Manager Sheila Santos made an unannounced visit for the purpose of conducting a required annual Inspection. LPAs were greeted and granted entry by care provider Samantha Dimichina after explaining the purpose of the visit. Administrator (AD) Alan Shelley was notified via telephone and later arrived to assist with the inspection. LPAs observed the Administrator certificate was current and expires March 24, 2025. This is a Residential Care Facility for the Elderly (RCFE) licensed to 6 non-ambulatory residents with a hospice waiver for 4. The facility is a one story home with six resident bedrooms, three bathrooms, and an attached three car garage. While waiting for the AD, LPAs began review of the records. LPA Guillen reviewed four resident records. All the required documentation were present and current in the residents’ files reviewed. LPA reviewed two employee records. All employee’s present have a criminal record clearance and were associated to the facility. LPAs observed staff records reviewed have a current First Aid certificate. During the inspection, LPAs and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: LPAs observed residents watching television in the living room and resting in their respective bedrooms. LPAs observed four residents in care and four staff present. LPAs observed the See Something Say Something Poster (PUB 475) mounted on the wall by the garage exit. LPA advised AD to have PUB 475 to be relocated to the entryway of the facility, AD proceeded to place the PUB 475 poster in the entry way of the facility; a technical advisory was given on today’s date. All resident bedrooms had the required furnishings. LPAs observed all resident beds had linens and blankets with additional linens stored in the hallway storage closet. LPAs observed bathrooms were clean and equipped with grab bars and non skid floor mats. LPAs observed all windows were appropriately screened. Continued on LIC 809-C Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 113.3 and 119.1 degrees Fahrenheit in resident's bathrooms. LPAs toured the outside of the facility and observed outdoor passageways were free of obstruction. LPAs observed the backyard had a shaded sitting area with furniture for resident use. LPAs observed the facility had a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with a service date of February 29, 2024 and located by the kitchen. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. The garage is used for storage with a portion of the garage converted to a staff room which is kept locked and inaccessible to residents. Toxic chemicals, cleaning solutions, and disinfectants were observed to be locked and inaccessible to residents in the bathroom and under the kitchen sink. Medication cabinet was observed to be locked and centrally stored in the kitchen however, during the medication review, medication named PreserVision was being administered to a resident without a prescription present at the facility; a Deficiency was cited on this date. LPAs observed the First Aid Kit had all the required components. LPAs observed the facility conducted their last emergency disaster drill on October 1, 2024 and is conducted every 3 months. Based on the observations made during today’s inspection, a deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was emailed to the Administrator due to a printer error.