Routine inspection·February 15, 2024

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Guardian Senior Homes on Madison. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the home and met with Caregiver Kai Mateo. Facility is licensed for 6 non-ambulatory residents, with a hospice waiver for 4. Facility has 6 residents during today's visit with 1 on hospice. Khan Do has an Administrator Certificate expiring on 04/26/2025. LPA Lyman along with Caregiver Kai Mateo toured the facility at 9:16 AM. LPA toured the physical plant, checked food service, and the first aid kit. The home consists of seven resident bedrooms, three resident bathrooms, one staff room, living room, dining room, and kitchen. Second story houses a tenant and no residents. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. 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 109.2 and 111.6 degrees F in all facility bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including tweezers, thermometer, and scissors. During today's visit, auditory door alarms are operational. LPA observed a locked storage area for cleaning supplies under the kitchen sink. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. At 9:30 AM, LPA observed unsecured medications and sharps in the kitchen. Smoke detectors and Carbon Monoxide detectors are hardwired and tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and observed ample shaded seating for residents. Exit gates are unsecured and operational. LPA observed residents relaxing in the facility and all appeared clean and well taken care of. Facility provides activities in the form of exercise and music therapy. CONTINUED ON LIC 809C DATED 2/15/2024. LPA observed emergency food and water supply. LPA reviewed the emergency disaster plan during the visit. Plan is thorough and complete. Facility provided documentation of last fire drill conducted on 02/17/2023. At 10:15 AM, LPA reviewed six resident files and two staff files. Resident files contained required documents including admission agreements, physician reports and resident appraisals. Staff files reviewed contained required health screen/TB, and criminal record clearance. One out of two staff files do not have documented required training hours. At 11:05 AM, LPA reviewed medication storage and administration. Medications are stored in a locked cabinet and are audited monthly by staff. 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.