Routine inspection·August 22, 2024

On 8/22/2024, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced visit to the facility for a required annual inspection. LPA met with Administrator, Yaninee Asawadilokchai who was informed of the purpose of the visit. LPA toured the facility with the administrator and observed the facility is made up of a one-story home with four (4) resident bedrooms, two (2) bathrooms, one (1) staff room, a kitchen, dining room, living room, and attached garage. During the tour, the administrator tested one (1) of the smoke alarms and carbon monoxide detectors and LPA observed it to be operational. LPA also observed a charged fire extinguisher mounted near the medication cabinet. Indoor and outdoor passageways were free of obstruction. The facility has outdoor shaded seating for the residents in care. There were no bodies of water observed on the premises. Medications are secured in a locked hallway cabinet. LPA toured the kitchen and observed the facility had a 2-day supply of perishable foods and 7-day supply of non-perishable food items. Staff present have a criminal record clearance and valid first aid/CPR certification. During tour of the kitchen, LPA observed a mortar and pestle with white residue inside the mortar. Administrator reported the facility uses the mortar and pestle to crush Resident 1's (R1's) medications and camouflages them in their apple sauce at the request of R1's family. LPA requested to review R1's records and observed R1's file was incomplete and did not have a physician's report, pre-admission appraisal, functional capabilities assessment or appraisal/needs and services plan. The administrator reported the facility does not have a physician's order to crush/camouflage R1's medication and R1 is not cognizant to provide consent. Administrator also reported R1 is bed bound, unable to reposition themselves or independently transfer to and from bed, and requires to be repositioned by staff every two (2) to three (3) hours. LPA interviewed R1's responsible person who corroborated the information reported by the administrator. Administrator and R1's responsible person reported R1 is not on hospice and is only receiving home health services at the facility twice per week. The facility did not have a copy of R1's home health care plan either. Per a Fire Safety Inspection Request (STD. 850) dated 2/22/2024, the facility has a fire clearance for six (6) non-ambulatory elderly residents. During tour of the facility, LPA reviewed the Facility Sketch (LIC 999) and observed the "office" is being used as Resident 2's (R2's) bedroom and "Bedroom 4" is being used as a staff room. Administrator also reported a toilet was installed in R2's room (the "office") after the facility's fire inspection on 2/22/2024. Based on the aforementioned the facility will be cited and assessed a civil penalty. An exit interview was conducted where this report was reviewed and provided to Administrator Asawadilokchai along with a Confidential Names List (LIC 811), LIC809-D and LIC421M.