Routine inspection·September 20, 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 administrator Juan Garcia Trujillo staff after introducing himself and stating the reason of the visit. During the inspection, LPA and staff conducted a tour of the physical plant and observed the following: The facility is a two-story home with two shared bedrooms and one private room in addition to the facility's common living areas and one attached garage. The second level of the house is for use by staff exclusively. There are two bathrooms including one en-suite bathroom. 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. One bed is observed to be equipped with full rails. Physician order and hospice plan of care reviewed.. There are currently four residents admitted to the facility, one of which is receiving hospice care. Bathrooms faucets and toilets are operational. Water temperature was measured to be approximately 110F. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed. Drills are conducted quarterly, they are however not documented. Consultation provided on Technical Assistance Advisory Note. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable. Smoke and carbon monoxide detectors tested operational. Fire extinguisher present is fully charged and has 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 is an adequately fenced empty swimming pool on the premises. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 Licensee plans to have the pool covered and is intending to obtain building permits from the city of Lake Forest. LPA informed licensee to provide modified floor plans and building permits to the Department. 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. The record of centrally stored medication dosages is however found to be outdated for two out of four residents. A type B deficiency is cited on an attached form LIC809-D. LPA reviewed four resident files and two staff files. One staff and two resident interviews conducted. Resident records include all necessary components. All staff members are confirmed to be cleared and associated with this particular licensed location. Training records are however missing for 2024. One staff member does not meet the annual requirement of 20 hours of training. A type B deficiency is cited on an attached form LIC809-D. CPR training on file and up-to-date. The poster for reporting information is observed to be posted but smaller than the required size. Technical Assistance Advisory Note provided. Infection Control Plan is not using the Department-issued for. Technical Assistance and copy of form LIC 9252 provided. Based on the observations made during today’s inspection, two type B deficiency are being cited per Title 22 Division 6 of the California Code of Regulations. Three Technical Assistance Advisory Notes are also provided along with related consultations to the licensee. An exit interview was conducted, and a copy of this report along with appeal rights was left at the facility.