Routine inspection·April 7, 2022

Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced visit to Pacifica Royale Assisted Living Community. The purpose of today's visit was to conduct a Required 1 Year inspection. LPA Velazquez was allowed entry into the facility and met with Activities Coordinator (AC) Ala Yarashevich. Administrator (AD) Edward Maslobodsky arrived later to assist with the visit. The facility is licensed for 66 ambulatory and 66 non-ambulatory residents. The facility also has a hospice waiver for 3 residents. The last emergency disaster drill was conducted on March 17, 2022. LPA was provided with a copy of the most recent Fire Authority permit which is dated July 29, 2021. LPA was also provided with a copy of the most recent liability insurance policy. At 9:01 AM LPA Velazquez conducted a tour of the physical plant along with AC Ala Yarashevich. The facility consists of 3 stories with 66 resident rooms each with their own bathrooms. The resident rooms are located on the second and third floors with the first floor referred to as the basement floor. The facility has 1 activity room/TV room, Bingo room, 1 dining room, kitchen, medication room, hair salon, a library room, 2 connected courtyards, and a lobby area. The resident bedrooms had the required furnishings, bed linens, and closet/drawer space to accommodate each resident comfortably. LPA Velazquez observed a postural support bar on one of the resident beds as well as bed rails. Resident bath towels and personal hygiene supplies were adequately stocked. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, showers were free of mold/mildew and a non-skid surface or mat was in place. LPA Velazquez tested the hot water temperature in 10 resident bathrooms and the temperature ranged from 109.9 degrees Fahrenheit to 116.9 degrees Fahrenheit verified by AC Ala Yarashevich. LPA Velazquez along with AC Yarashevich tested the signal system and found one room had an inoperable alarm which was verified by AC Yarashevich. LPA Velazquez inspected the kitchen along with AC Ala Yarashevich. Perishable and non-perishable food supply was checked and adequately stocked at the time of the visit. Emergency food supply was also checked and adequately stocked. Fire Extinguishers throughout the facility were fully charged. Toxins, sharps, and medications were locked and inaccessible to residents. First Aid kit was checked and found to be in order. The facility had a First Aid guide and LPA Velazquez advised AD Maslobodsky to obtain an updated First Aid manual. LPA Velazquez along with AC Ala Yarashevich toured the outside grounds and no bodies of water were observed. There was shading and sufficient seating for residents. Walkways around the facility were clear of hazards There were no security bars or weapons on the premises. No resident or staff files were reviewed at the time of this visit. LPA Velazquez informed AD Maslobodsky to ensure a written physician's order for the bed rails and the postural support bar is present in the resident's file pursuant to Title 22 Regulation Section 87608 Postural Supports. Deficiencies cited under California Code of Regulations Title 22, Division 6, Chapter 8. An exit interview was conducted with Administrator Edward Maslobodsky and a copy of this report along with the appeal rights and a copy of the LIC 9098 were provided at the time of this visit.