Routine inspection·November 18, 2024

On 11/18/2024 at 12:12 PM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Brown met with a Staff #2 (S2) and was granted entry to the facility. At the time of the visit there was one (1) staff present, and five (5) residents present. Licensee/Administrator Michelle Matamoros was contacted and informed of the visit. Licensee/Administrator Matamoros arrived during the visit. LPA Brown explained the purpose of the visit to LIcensee/Administrator Matamoros. The facility is a five (5) bedroom, two (2) bathroom home with a kitchen, dining area, living room, and an attached garage. The facility is a Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) non-ambulatory residents and two (2) resident may be bedridden. The facility's approved for four (4) Hospice Waiver. The current census is five (5) residents. LPA Brown was accompanied by Licensee/Administrator Matamoros and S2 to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant : The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to interior and exterior passageways. The facility is maintained at a comfortable temperature of 75 degrees Fahrenheit. LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA Brown observed sufficient furniture and lighting throughout the facility. LPA Brown measured and observed the water temperature in the residents/staffs shared bathroom to be at 113.9 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Postings such as the facility license, personal rights, the CCLD complaint poster, ombudsman poster, labor laws and the disaster plan were posted in a common area. Cleaning supplies, toxins were kept inaccessible to residents in care. There was a designated storage space for resident/staff files.***Continuation in LIC809C*** Medications are kept inside the medication cabinet in the hallway inaccessible to residents. Overall, the facility is clean, in good repair for residents in care. During the tour of the facility, LPA Brown observed Resident #3 (R3) has a full bed rail but per documents review and staff interview, R3 is not on hospice and there's no letter submitted to CCLD and approved by CCLD for the full bed rail. Deficiency will be issued. Moreover, LPA Brown observed two (2) sharp metal skewers in the kitchen drawer, not locked and accessible to residents in care. Deficiency will be issued. Food Service : Seven (7) days non-perishable and two (2) days perishable food supply observed at the facility. Care & Supervision : LPA Brown observed that there's no staff scheduled to work the night shift, as required for facility with dementia residents. Deficiency will be issued. Record Review : LPA Brown did not observe Infection Control Plan maintained at the facility. Deficiency will be issued. LPA reviewed three (3) resident files for admission agreements, updated physician reports, pre-placement appraisals, needs and services plans, centrally stored medication list. LPA Brown observed Resident #2 (R2), Resident #3 (R3) do not have the required Pre-Admission Appraisal in their facility file. Deficiency will be issued. Also, LPA Brown observed no Appraisal Needs and Services Plan for Resident #2 (R2) and Resident #3 (R3). Deficiency will be issued. LPA reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test results. LPA Brown observed Staff #2 (S2) does not have the required Health Screening/Medical Assessment in S2 personnel file. Deficiency will be issued. LPA Brown observed Staff #2 (S2), Staff #3 (S3) do not have the required 20 hours training annually. Deficiency will be issued. LPA Brown observed Staff #2 (S2) and Staff #3 (S3) do not have the required 10 hours of initial training maintained in their facility file. Deficiency will be issued. Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), LIC809D, LIC9102 and Appeal Rights were discussed and provided to Licensee/Administrator Michelle Matamoros.