Routine inspection·September 26, 2024

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Iris Guest Home. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the facility and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents of which 1 may be bedridden. Facility has an approved hospice waiver for 5 residents and the home currently has 4 residents on hospice. Administrator/ Licensee Brevet Dao arrived during the visit. Administrator Jean Veracruz has an administrator certificate valid until 06/01/2026. LPA Lyman along with Caregiver Norbi Banggalat toured the facility at 8:25 AM. LPA toured the physical plant, checked food service, first aid kit and reviewed records. The home consists of three resident bedrooms, 2 common restrooms, one staff room, living room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed a closet threshold in disrepair in room #3. Resident restrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured 103.1 degrees F in one common restroom. At 8:40 AM, LPA is unable to measure water temperature in second common restroom as the sink is overflowing with water. 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. Auditory exit alarms are turned off during today's visit. First aid kit had all the elements including thermometer, tweezers and scissors as well as a first aid manual. LPA observed toxins are secured during today's visit. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA tested smoke detectors during today's visit. Smoke detectors in room #1 and the hallway are non-operational. Fire extinguisher is fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample seating for residents. At 8:45, LPA observed back exit gate does not easily open. LPA observed ample emergency food and water supply. LPA reviewed the emergency disaster plan and plan is thorough and complete. CONT ON LIC809-C DATED 09/26/2024. Facility provided documentation of last fire drill conducted on 07/06/2024. Facility provides activities in the form of exercise, and karaoke. At 9:30 AM, LPA reviewed six resident files and four staff files. Resident files contained required documents including admission agreements, physician reports and resident appraisals. Resident 1 (R1) does not have a physician order on file for half bed rails. Staff files reviewed contained required documentation of medical clearance/ TB, CPR training and criminal record clearance as well as required training. At 10:15 AM, LPA reviewed medication storage and administration. Medications are stored in a locked closet. 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.