Routine inspection·August 11, 2023

Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced annual required visit. LPA was granted entry and met with Caregiver, Anda Jac, who was informed of the purpose of the visit. At the time of the visit there was (1) staff and four (4) residents present. The facility is a two story home with seven (7) bedrooms and (3) bathrooms with attached garage (four (4) bedrooms and two (2) bathrooms upstairs are designated for the live in licensee/family). The clients served are elderly adults 65 years and older. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted a staff and client interviews. LPA observed the following: Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed staff records and found that all staff had infection control training. Physical Plant: LPA observed the client bedrooms and staff office. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. LPA observed outdoor furniture and shaded area for clients. Laundry equipment was observed to be in good working condition. LPA observed chemicals and cleaning solutions under the kitchen's sink cabinet unlocked and accessible to the residents. LPA observed chemicals and laundry detergent in the unlocked garage accessible to the residents. This requirement does not meet Title 22 regulations and LPA will issue a deficiency along with a plan of correction. The smoke detector and carbon monoxide was operational, and the hot water temperature 115.7 F. Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed containers of expired milk, orange juice, and a carbonated drink in the refrigerator. The food/beverages was not kept in good quality that meets Title 22 Regulations. A deficiency will be issued along with a plan of correction. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. Care & Supervision / Administration: Adequate staff are present for the supervision of clients during the visit. LPA also reviewed the staff scheduled showing adequate staff coverage. Facility sketch, exit routes, personal rights, complaint information and emergency phone numbers were found posted in the facility. The listed administrator possesses a current administrator's certificate. Record Review and Resident/Staff Files: LPA reviewed three (3) staff files and training. LPA observed Staff One (S1) was not associated to the facility. A civil penalty will be issued. LPA observed S1 did not have a current CPR/First Aid Certificate on file which does not meet Title 22 Regulations and a deficiency along with a plan of correction will be issued. Four (4) resident files were reviewed and possessed all required paperwork. Health Related Services/ Incidental Medical Services: All client medication was locked in the garage in a cabinet. LPA reviewed resident medications for four (4) residents and found that discrepancies between the MARS issued to the residents and the medication the facility had for Resident One (R1) and Resident Two (R2). Facility does not document daily dispensing of medication to the residents and S1 stated they only go by what is written on the bottles/bubble pack. For R1, SIMVASTATIN 10 MG is supposed to be given to R1 in the evening per Physician's orders but on the bubble pack the facility wrote in "AM". The bubble pack for SIMVASTATIN was issued on 08/01/2023 and had the 11th date popped out and dispensed. LPA observed facility was giving R1 PRN medication ACETAMINOPHEN without documenting the date, time, and dosage that was given which does not meet Title 22 regulations and a deficiency will be issued along with a plan of correction. LPA observed 9 medications for R2 that was on the Physician's order was not at the facility. LPA inquired about it to the Administrator and she stated she was not sure where the medication was due to the resident recently returned from the hospital today 08/11/2023. Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation in the facility's Emergency and Disaster plan that showed they have not conducted a fire drill within the year and their Fire/Earthquake drill form was from 2018, which does not meet the department requirements. A deficiency will be issued along with a plan of correction. LPA observed all facility exits were clear from obstructions. LPA observed emergency supplies in the garage and first aid kit with all required items. An exit interview was conducted where a copy of this report, deficiency page LIC809D, Civil Penalties, and appeal rights was provided to caregiver, Anda Yac.