Routine inspection·October 14, 2022

On 10/14/2022, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility in order to conduct a required annual inspection. LPA was greeted and granted entry by Leodigario Garais, caregiver after explaining the purpose of the visit. Administrator Brevet Dao was notified by phone, but was not available to assist with the visit in person. Infection Control measures were reviewed over the phone. Administrator agreed to review the final report over the phone as well and authorized her staff to sign on her behalf. At approximately 11:15am, LPA accompanied by caregiver toured the physical plant of the facility. There are currently six (6) residents in care, three (3) of which are receiving hospice care. Residents are observed relaxing in their respective bedrooms or in the common areas. One resident is observed to not be dressed and only able to cover his chest up with a bedsheet which is a deficiency in regards to their dignity and personal rights. More residents are observed in beds equipped with postural supports than there are residents stated on hospice, which prompted LPA to request the residents records on file to search for the required doctor's orders. Facility staff was only able to present resident files for 3 residents out of the 6 observed at the facility. Caregiver indicates that the three other residents were admitted this week and that the administrator is working on organizing the files. Bathrooms are equipped with grab bars and slip mats. The main bathroom for use by the residents has a dirty floor, which LPA documented in photographs. An sufficient supply of linen is observed. Sharp instruments are kept unsecured in a kitchen drawer without a functioning lock. Cleaning supplies are store unsecure under the kitchen sink as well as in the laundry closet which is not equipped with a lock either. The centrally stored medication is located in a closet in the hall leading to the bedrooms. While a padlock can be used, the closet was unlocked at the time of the visit. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 LPA observed a sufficient supply of food and water present. Caregiver indicates that the next market day is on Saturday. The fire extinguisher present is charged and has been recently maintained. Staff member S1 is adequately cleared and associated in Guardian, however the other caregiver present (S2) is not cleared nor associated. LPA and caregiver toured the outside of the facility. While the exit routes are mainly clear, there is a large quantity of clutter present such as broken television sets or bags full of cans to be recycled. LPA provides consultation that exterior spaces need to be cleared of excessive debris. Outdoor furniture and a shaded area are present in the backyard for the enjoyment of residents and visitors. The entrance gates on both sides of the house are self-latching. There are no bodies of water on the premises. LPA observed a bedroom used by caregiving staff separated from the living room and entertainment area with a curtain suspended in the door frame. Vitamins or dietary supplements are seen in the unsecured room on the night stand next to the bed. Based on the observations made during today’s visit, six (6) deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Four Technical Assistance Advisories are also issued. This report was reviewed over the phone with facility administrator and signed by authorized facility representative. A copy of this report along with appeal rights was provided and left at facility.