Routine inspection·December 2, 2024

On this day, Licensing Program Analysts (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 the caregiving staff after introducing himself and stating the purpose of the visit. Administrator Jennifer Perez was notified of the visit via telephone and arrived later to assist. LPA accompanied by facility staff conducted a tour of the physical plant and observed the following: the facility is a two-story home with an attached garage. The upper level is only for use by licensee and their family and staff and is kept inaccessible to residents as verified during the visit. The facility's ground level has three shared bedrooms and two shared bathrooms. All bathrooms are observed to be equipped with grab bars and slip mats. All resident bedrooms have the required furnishings. Bathrooms faucets and toilets are operational. Water temperature was measured at 130.5F and 135.2F in two bathrooms used for personal hygiene. Type B citation issued. LPA observed all beds have linen and blankets. There are half rails used for postural supports for three residents. Physician orders for two residents reviewed. A third resident received half rails ordered upon their admission, physician orders pending from skilled nursing. There are currently six residents admitted to the facility with one of these residents currently admitted to rehabilitative care. Two residents are receiving hospice care out of a waiver capacity of two possible hospice residents. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. One occurrence of an evacuation drill has been conducted in 2024 for both shifts. Type B citation issued due to the quarterly frequency not being followed. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke and carbon monoxide detectors tested operational. Fire extinguisher present is fully charged and has been purchased in 2024 as demonstrated by the receipt on display. 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. The route of egress on one side is free of obstructions, however there are construction materials partially blocking the path to the second gate. Technical Violation Advisory note issued. Cleaning products are observed to placed in a lockable cabinet under the sink which staff state is locked at night. Consultation provided to remind licensee of the need to lock the cabinet when not attended directly by staff. The medication central storage was also observed to be secure and reviewed to be accurate and up to date with the resident's prescription orders. LPA reviewed six resident files along with two staff files. Resident records include all necessary components. All staff members on the facility's roster are confirmed to be cleared and associated with this particular licensed location. Training verified to be up to date. CPR stated to have been conducted. Proof of training to be sent to LPA as soon as possible. Health screenings are on file for both staff members. Proof of liability insurance coverage could not be provided. Licensee states that finding an insurance company to renew their previous contract has been challenging. Type B citation issued. Based on the observations made during today’s inspection, three deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations and four Advisory Notes issued. An exit interview was conducted and a copy of this report along with appeal rights was provided to a facility representative.