Routine inspection·May 23, 2025

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 6 residents and the home currently has 5 residents, with 1 resident on hospice. Staff provided liability insurance that expires on 10/19/2025. LPA along with staff member 2 (S2) toured the facility at 8:35 AM. LPA toured the physical plant, checked food service and facility documentation. The home consists of 3 resident bedrooms, living room, dining room, kitchen, two staff rooms with one built into the garage, as well as 2 bathrooms. LPA toured the kitchen and observed sharps locked in a cabinet during today's visit. At 8:40 AM, LPA observed a kitchen cabinet with a broken lock containing medication. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit . LPA observed the emergency food. At 8:58 AM, LPA observed there is no emergency water at the facility. 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. At 9:09 AM, LPA observed unlocked bathroom cabinet with cleaners such as Comet bleach powder and Clorox wipes inside bathroom in bedroom 3. Water temperature measured between degrees 114.4 F and 114.9 in all bathrooms. 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 . Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. Continued on LIC809-C dated 5/23/2025. LPA observed a staff room built into the garage. This room does not appear in the approved facility sketch and was built after licensure without informing the Department. At 9:30 AM, LPA observed closet by the main entrance is unlocked, containing cleaning supplies. Outside grounds were toured. Walkways around the home were clear of hazards. First aid kit contained all required items including tweezers, scissors and thermometer. There is shaded outdoor seating for residents. Exit gate is unlocked and operational. LPA reviewed five resident files and three staff files. Resident files did not contain all the required documentation. Resident 1 (R1) did not have a signed Personal Rights form on file. Personal Rights documents for resident 2 (R2), resident 3 (R3), resident 4 (R4), and resident 5 (R5) were not fully completed. R2's file did not contain bed rail orders. LPA observed R2's bed with full bed rails. Staff files reviewed did not contain required documentation as it was revealed through LPA's record review and interviews that training files for Staff 1 (S1), S2, and staff 3 (S3) are falsified . LPA reviewed medication storage and administration. Medications are stored in a kitchen cabinet. Based on LPA observation and record review, medications are not being administered per physician order for R1, R3, and R5. During today's inspection, it was revealed the Administrator is out of the country and there is no designated backup Administrator available. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough . Based on LPA record review and interviews, no disaster drills are conducted at the facility. Based on the observations made during today’s visit, 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.