Incident investigation·July 28, 2023

Licensing Program Analysts (LPAs) Joseph Alejandre and Dwayne Mason made an unannounced case management visit (See complaint #22-AS-20230721153400 dated 7/21/23). Earlier in the day , an attempted visit was initiated earlier this morning by Department personnel which had to be ended due to safety concerns. LPAs Mason and Alejandre conducted a Health and Safety visit at the facility to ensure the safety of the residents and staff and to retrieve State equipment. LPAs were greeted and granted entry by staff and explained the reason for the visit. LPAs along with staff toured the facility and reviewed resident medications and records. LPAs observed all residents were asleep at the time of the visit. LPAs observed both resident bathrooms were clean and operational. LPA observed a 7 day non-perishable and 2 day perishable food supply on hand. LPAs observed the facility had electricity, gas and water service. During the visit the facility temperature was 79.8 degrees Fahrenheit. LPAs observed a rodent caught in a trap in the water heater closet next to the bathroom. LPAs reviewed R1's medication records. R1 was prescribed Metformin 1000 mg twice a day, Simvastin 20 mg once a day, One-Daily Multivitamin one tablet a day, and Lisinopril 10 mg once a day. A review of R1's medication administration record shows R1 was not administered any medication on June 30, 2023. LPAs observed the kitchen was clean and organized. LPAs observed the see something say something poster (PUB 475) posted in the hallway. LPAs observed the fireplace in the living room is screened. LPAs observed water leaking from a drain pipe on the outside walkway leading to the back exit gate. LPAs observed next to the back exit gate, adjacent to the garage an old chair, nightstand and a dresser. LPAs observed the cleaning supplies are kept locked under the sink. LPAs observed the knives and sharp objects are kept locked in the caregiver's room. Based on the observations made during today's visit deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations and a civil penalty is being issued for a repeat violation within a 12 month period. An exit interview was conducted and a copy of the report along with appeal rights was provided.