Routine inspection·April 23, 2024

Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Teresa Espinoza, Supervisor, and discussed the purpose of the visit. The facility is a single story, (5) bedroom, (3) bathroom, Residential Care Facility for the Elderly (RCFE) with a license capacity of (6) and a current census of (5) residents in care. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following: Physical Plant/Environment: Indoor and outdoor passageways are free of obstruction. The facility has no swimming pools or similar bodies of water. Outdoor shaded area is sufficient for resident activities and is enclosed with a self-latching gate. The facility has sufficient lighting and is maintained at a comfortable temperature. Resident’s showers, toilets, and hand washing areas were in operating condition and equipped with grab rails and non-slip mats. The hot water temperature in residents' bathrooms measured 108 and 117 degrees F. Resident’s bedrooms had beds, bed linen, dressers and sufficient lighting. The facility has operating carbon monoxide alarms and telephone service. The facility has sufficient linen, towels, and personal hygiene items for residents. The facility has posted in a common area, facility license, Community Care Licensing complaint poster, Ombudsman poster, Resident's Personal Rights, evacuation exit plan and emergency telephone numbers. Sharps, disinfectants, and cleaning solutions are kept in a locked cabinet inaccessible to residents in care. Food Service: Facility kitchen and dining areas are maintained clean. The facility has sufficient non-perishable and perishable food supply for residents in care. The facility's refrigerator and freezer were operating in a healthful manner. Care & Supervision : Facility has 24-hour, 7 days a week care staff, staff present at the facility had criminal record clearances with the Department. Medical Related Services : Resident’s medications are labeled and centrally stored in a locked cabinet. Record Review: The facility’s Administrator’s certification and liability insurance are current. The facility’s last fire drill was conducted on 1/10/24. LPA review of staff files reveals, staff #1 (S1), staff #2 (S2), and staff #3 (S3) did not have record of tuberculosis results and did not have an employment record/application containing Employee's full name, Social Security number, date of employment, home address on file. In addition, the facility did not maintain record of S3's first aid/CPR and dementia training. LPA review of resident files reveal, resident #1 (R1), resident #2(R2), resident #3(R3), resident #4 (R4) did not record of tuberculosis results. In addition, the facility did not maintain record of a pre-admissions appraisal for R1 . LPA review of facility's hospice waiver reveals the facility has an approved hospice waiver for (2) residents; however, all (5) residents are receiving hospice care. Based on observations and record review, deficiencies are being cited per Title 22, of The California Code of Regulations and Health and Safety codes. This report was reviewed with Supervisor Espinoza and a copy with Appeal Rights was provided to Supervisor Espinoza and the conclusion of the visit.