Routine inspection·September 25, 2024

On this day, Licensing Program Analyst (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 facility caregiving staff after introducing himself and stating the reason of the visit. Administrator Richard Mendoza arrived later to assist with the visit. During the inspection, LPA and staff conducted a tour of the physical plant and observed the following: The facility is a one-story home with four private and one shared bedrooms in addition to a staff room. There are two bathrooms throughout the facility. All bathrooms are observed to be equipped with grab bars and slip mats. All resident bedrooms have the required furnishings. LPA observed all beds have linen and blankets. Postural supports with corresponding orders are observed, however one bedroom is equipped with full length rails in spite of the resident not currently receiving hospice care. Type B citation issued. There are currently five residents admitted to the facility, none of which are receiving hospice care. Bathrooms faucets and toilets are operational. Water temperature was measured to be within acceptable temperature range. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. Drills are conducted quarterly however they are not systematically documented. Consultation provided. 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 extinguishers present are fully charged and have been maintained in 2024. There is adequately shaded outside space with outdoor furniture present. There are self-latching gates on both sides of the property. The routes of egress are free of obstructions. There are no bodies of water on the premises. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 Medication, cleaning products and sharp items are confirmed to be inaccessible throughout the physical plant. 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. Medication is observed to be prepared two to three days ahead of dispensation. Consultation provided on pre-pouring medication as a Technical Violation Advisory Note. LPA reviewed five resident files and 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 records are maintained at an administrative location off-site. Training and CPR stated to be up to date. Physician reports need to be updated for three residents with a diagnosis of dementia. Type B citation issued. Based on the observations made during today’s inspection, two type B deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Three Advisory Notes issued along with consultations provided to the licensee. An exit interview was conducted and a copy of this report along with appeal rights was provided to a facility representative.