Routine inspection·March 17, 2025

On 03/17/2025 at 09:15 AM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct the required comprehensive annual inspection. LPA Brown met with a staff and was granted entry to the facility. Licensee/Administrator Josephine Mesina was informed of the visit and arrived during the visit. LPA Brown informed Licensee/Administrator Mesina of the purpose of the visit. At the time of the visit there were two (2) staffs present, and four (4) residents present. The facility is a five (5) bedroom, two (2) bathroom home with a kitchen/dining area, living room/activity room, laundry room and an attached garage. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of five (5) non-ambulatory residents. The facility’s approved for four (4) hospice waiver. The current census is four (4) residents. LPA Brown was accompanied by Staff #2 (S2) to conduct a general overall inspection, which included, but was not limited to the following: Physical Plant : LPA Brown observed Resident #1 (R1) and Resident #3 (R3) were reported bedridden by their physician and the facility does not have an approved fire clearance for bedridden residents. Deficiency will be issued today, 03/17/2025 and an immediate civil penalty of $500.00 will be assessed and will continue to be assessed until corrected. There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 71 degrees Fahrenheit (F). LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, 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 resident bathroom to be at 106.5 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Charged fire extinguisher was also observed at the facility. Posters such as personal rights, Ombudsman poster, and the disaster plan, House Rules and Theft and Loss Policy were posted in a common area. However, LPA Brown observed the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) was not posted at the facility. Technical Violation will be issued. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. ***Continuation in LIC809C *** There is a medicine cabinet with the resident’s medications locked. LPA Brown observed a complete first aid kit and first aid book at the facility. Moreover, LPA Brown noted that the facility has the required emergency supplies, emergency food and emergency water maintained at the facility. Food Service : More than seven (7) days’ supply of non-perishable foods and more than two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. Care & Supervision : The facility has an Administrator present at the facility with appropriate and enough hours to appropriately manage the facility. The facility has sufficient number of staff to provide care and supervision to the residents in care. LPA Brown noted that the facility has a staff scheduled to work at night, awake and on duty as required for facility with dementia residents. Record Review : LPA Brown noted that the facility has an updated Infection Control Plan, Emergency Disaster Plan and updated Liability Insurance. LPA Brown reviewed four (4) resident files for admission agreements, updated physician reports, pre-placement appraisals, centrally stored medication list/physician orders and needs and services plans. LPA Brown noted that Resident #1 (R1) and Resident #2 (R2) Admission Agreements were not signed and dated by the Licensee or LIcensee's Designated Representative. Deficiency will be issued. Moreover, LPA Brown noted that Resident #4 (R4) half bed rail has written order from R4's physician indicating the need for half bed rail for mobility. LPA Brown reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test result. LPA Brown observed that staff files reviewed were complete. During medication audit, LPA Brown observed that staffs at the facility are assisting their residents with their medications per their doctor's order. No issues observed. Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, Chapter 8 of the California Code of Regulations (CCR). An exit interview was conducted, and this report (LIC809), LIC809D, LIC421 IM and Appeal Rights were discussed and provided to Licensee/Administrator Josephine Mesina.