Routine inspection·November 22, 2024

On this day, Licensing Program Analysts (LPAs) Kevin Saborit-Guasch and Brandon Lopez made an unannounced visit to the facility for the purpose of conducting the required annual inspection. LPAs were greeted and granted entry by facility caregivers after introducing themselves and stating the purpose of the visit. Administrator Bryan Estorba was notified by telephone and arrived later to assist with the visit. LPAs accompanied by facility staff conducted a tour of the physical plant and observed the following: the facility is a one-story home with an attached garage. The facility has four private bedrooms and one shared bedroom. All resident bedrooms have the required furnishings. LPAs observed all beds have linen and blankets. There are full rails used for postural support in two rooms. Physician orders for both were reviewed, along with the hospice plans of care. There is one shared bathrooms, which is observed to be equipped with grab bars and slip mats. Bathrooms faucets and toilets are operational. Water temperature was measured at 114.4F. There are currently four residents admitted to the facility, including one admission who is currently in a skilled nursing facility for rehabilitation. There are two residents receiving hospice care. LPAs observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. Drills are conducted quarterly and documented. LPAs observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Some canned good in the garage are however observed to be expired. Type B citation issued. Smoke and carbon monoxide detectors tested operational. Fire extinguishers present is fully charged and has been maintained in 2024. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 There is adequately shaded outside space with outdoor furniture present. There are self-latching gates on each side of the property, however one of the latching mechanism is stuck and does not allow passage. Type B citation issued. There are no bodies of water on the premises. Cleaning products and sharp items are confirmed to be inaccessible throughout the physical plant. The medication central storage is however observed to have been left unlocked at the onset of the visit. Identically, the hospice comfort kits are stored in unlocked boxes in the attached garage, which is accessed through a door which can be easily unlocked. Type B citation issued. The medication central storage was reviewed to be accurate and up to date with the resident's prescription orders. LPAs reviewed four resident files along with three staff records. Resident records include all necessary components. One admission agreement is missing one signature. Consultation provided. Review of the resident's records indicate a resident with diabetes who is stated to be self-administering their own insulin. Physician report review states the resident is not able to self-administer and monitor. Type B citation issued. All staff members on the facility's roster are confirmed to be cleared and associated with this particular licensed location. Training and CPR training verified to be up to date. Health screenings are on file for all staff members. COVID mitigation plan in use in lieu of Infection Control Plan. Consultation and form LIC9828 provided. Based on the observations made during today’s inspection, four type B deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. One consultation provided. An exit interview was conducted and a copy of this report along with appeal rights was provided to a facility representative.