Routine inspection·October 1, 2024

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Lois Guest Home II. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the facility and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 2 residents and the home currently has 2 residents on hospice. Licensee Louie Dormido arrived during the visit. Administrator Ken Forsythe has an administrator certificate valid until 02/15/2025. LPA Lyman along with Caregiver Manalili toured the facility at 9:50 AM. LPA toured the physical plant, checked food service, first aid kit and reviewed records. The home consists of six resident bedrooms, 2 common restrooms, 1 jack and jill restroom, staff room, living room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident rooms are single occupancy. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 119.8 and 130.6 degrees F in all facility bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. At 10:00 AM, LPA observed the wall and doorjamb in the jack and jill restroom is damaged. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the elements including thermometer, tweezers and scissors. LPA observed toxins are secured during today's visit. Kitchen was inspected. LPA observed part of kitchen is being used as storage space with items and debris present. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. At 10:10 AM, LPA observed multiple expired items in the refrigerator such as salad dressing, cheese and spoiled broccoli. LPA observed two resident's medications unsecured in the refrigerator. Smoke detectors and carbon monoxide detectors tested operational during today's visit. LPA observed two smoke detectors are in need of batteries. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there are no safety concerns noted. Exit gates are unlocked and operational. LPA observed ample emergency food. LPA reviewed the emergency disaster plan and infection control and plans are thorough and complete. CONT ON LIC809-C DATED 10/01/2024 Facility provided documentation of last fire drill conducted in September 2024. Facility provides activities in the form of exercise, and karaoke. LPA reviewed five resident files and three staff files. Resident files contained required documents including admission agreements, physician reports and resident appraisals. Staff files reviewed contained required documentation of medical clearance/ TB, CPR training and criminal record clearance as well as required training. LPA reviewed medication storage and administration. Medications are stored in a locked cabinet. Medications are being administered per physician order. Based on the observations made during today's visit, the following violations are being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report as well as appeal rights were discussed and provided with facility representative.