Routine inspection·January 17, 2025

On this day Licensing Program Analysts (LPAs) Andrea Mendevil 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 4 non-ambulatory residents, 2 ambulatory residents which one can be bedridden. Facility has an approved hospice waiver for 4 residents and the home currently has 6 residents. Administrator (AD) Adriel Pao arrived shortly to help conduct facility inspection. AD Pao has a valid certificate that expires on July 19,2026. The facility is currently remodeling the kitchen and it is not available for use. LPAs along with staff Joy toured the facility at 8:25 AM. LPA toured the physical plant, checked food service, facility documentation and the first aid kit. The home consists of 6 resident bedrooms, living room, dining room, and kitchen as well as 2 restrooms and 1 staff 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 116.4 degrees F and 117.5 degrees F in all restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. LPA observed sharps unlocked in a cabinet in the living room during today's visit. Perishable and non-perishable food supply was checked and not adequately stocked at time of visit. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPAs reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility has never conducted quarterly emergency drills. Outside grounds were toured. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. First aid kit did not contain all required items and missing tweezers. Facility conducts activities in the form of exercise and movies. There is no shaded outdoor seating for residents. One out of two exit gates is blocked by construction debris. CONTINUED ON LIC 809C DATED 1/17/2025. LPA observed the emergency food and water supply. There was no emergency water supply during the visit. LPAs reviewed six resident files and three staff files. The staff has not completed the required annual training for 2024 or 2025. Physician's reports were missing for 2 out of 6 residents. There are no reappraisals for 2 out of 2 dementia residents. Bed rail orders were missing for 3 out of 4 residents. The facility temperature measured 66 degrees F during today's visit. LPAs reviewed medication storage and administration. Medications are stored in a locked closet and in the kitchen refrigerator. Based on the observations made during today’s visit, 17 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.