Routine inspection·November 20, 2024

On 11/20/2024 at 01:18 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 and was granted entry to the facility. Licensee/Administrator Chrystal Condit was informed of the visit and arrived at the facility during the visit. At the time of the visit there were two (2) staff present, and three (3) residents present. The facility is a three (3) bedroom, two (2) bathroom home with a kitchen/dining area, living room/activity room, laundry room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) non-ambulatory residents of which two (2) may be bedridden. The facility’s approved for four (4) hospice waiver. The current census is three (3) residents. LPA Brown was accompanied by Licensee/Administrator Condit 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 indoor and outdoor 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, 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 bathroom to be at 107 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Fire extinguisher was also observed at the facility. Posters such as personal rights, the CCLD complaint poster, and the disaster plan were posted in a common area. LPA Brown observed Resident #2 (R2) has half bed rail and per interview and documents review, R2 does not have a written order from R2 physician indicating the need for half bed rail for mobility. Deficiency will be issued. ***Continuation in LIC809C *** 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. There is a Medicine closet with the resident’s medications locked. LPA Brown observed the complete first aid kit and first aid book 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. Record Review : LPA Brown observed the facility has an updated liability insurance. LPA Brown did not observe Infection Control Plan maintained at the facility. Deficiency will be issued. LPA Brown reviewed two (2) resident files for admission agreements, updated physician reports, pre-placement appraisals, centrally stored medication list and needs and services plans. LPA Brown observed no completed preplacement needs and services plan for Resident #1 (R1) and Resident #2 (R2). Deficiency will be issued. LPA Brown observed incomplete Centrally Stored Medications list for Resident #1 (R1) and Resident #2 (R2). Deficiency will be issued. LPA Brown reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test result. LPA Brown observed no documentation of the required 40 Hours training provided to Staff #2 (S2). Deficiency will be issued. LPA Brown observed no additional 20 hours annual training were provided to Staff #2 (S2). Deficiency will be issued. LPA Brown observed Staff #2 (S2) does not have the required four (4) hours of medication training and S2 and Staff #3 (S3) do not have the required six (6) hours of hands-on shadowing training. Deficiency will be issued. LPA Brown observed no medication record at the facility for Resident #1 (R1) and Resident #2 (R2) and there's no proof to show that staff at the facility are assisting R1 with R1 medication per R1's doctor's order as one (1) medication of R1's missing and no medication record was maintained at the facility to show medication was given per R1's physician order. Deficiency will be issued. In addition, LPA Brown observed the facility does not have the required emergency supplies, food and water maintained at the facility. Deficiency will be issued. Also, LPA Brown observed that the Licensee did not review, sign and date the Emergency Disaster Plan. Deficiency will be issued. ***Continuation in LIC809C*** Moreover, LPA Brown observed Resident #2 (R2) does not have the annual medical assessment as required for resident with dementia. 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 and Appeal Rights were discussed and provided to Licensee/Administrator Chrystal Condit.