Routine inspection·January 22, 2025

On this day Licensing Program Analysts (LPAs) Samer Haddad and Fred Arias made an unannounced visit to conduct a required annual visit. LPAs were greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for 55 non-ambulatory residents. Facility has an approved hospice waiver for 25 residents and the home currently has 49 residents, with 15 residents on hospice. Administrator (AD) Aurelia Olais arrived shortly to help conduct facility tour. AD Olais has renewed her Administrators certificate and is currently pending as of 9/30/2024. AD provided updated liability insurance that expires on 7/17/2025. LPAs along with staff Paula Tanglao toured the facility at 8:30 AM. LPAs toured the physical plant, checked food service, facility documentation and the first aid kit. The facility is a one-story complex with twenty-eight resident apartments. Each apartment has either its own private bathroom or shares a jack-and-jill style bathroom with another apartment. The facility also houses two common bathrooms, three large shower rooms, kitchen, dining room, living room, sun room, laundry room, activity room and medication room. 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 117.5 degrees F and 120.5 degrees F in all bathrooms checked. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Auditory exit alarms were operational during today's visit. LPAs toured the kitchen and observed sharps locked behind the kitchen entrance door during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Stove in kitchen has 3 out of 6 burners non-operational. LPAs observed one kitchen drawer to have rotted out. Facility is planning to replace all cabinets on 1/27/2025. LPA reviewed cabinet quote provided by Fireworks Fire Protection Services. Smoke detectors were serviced on 1/6/2025. Fire extinguishers were fully charged. LPAs reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility conducts quarterly emergency drills with the last drill conducted on 10/17/2024. Outside grounds were toured. Walkways around the facility were clear of hazards. Continued on LIC809-C Dated 1/22/2025 There are no security bars or weapons on the premises. First aid kit contained all required items including tweezers, scissors and thermometer. Facility conducts activities in the form of exercise, bingo, and music therapy. There is shaded outdoor seating for residents. Exit gates are unlocked and operational. LPAs observed the emergency food and water supply. LPAs reviewed five resident files and five staff files. All resident files contained required documentation including admission agreements, physician reports, resident appraisals, and physician orders for bed rails as indicated. Staff files reviewed contained required documentation including required annual training, medical assessment/ TB, criminal record clearance and proof of CPR training. LPAs reviewed medication storage and administration. At 9:00am, Medications were observed stored in a medication room that was unlocked with a med-tech present in the room at the time of visit. Some medications were on the counter. The medication room has an open wall facing the main entrance of the facility. Based on the observations made during today’s visit, two deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided along with appeal rights.