Routine inspection·December 21, 2023

On 12/21/2023 at 09:00 AM, 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, was granted entry to the facility. At the time of the visit there were three (3) staff present, and five (5) residents present. Licensee/Administrator Linda Thomas was contacted and arrived during the visit. The facility is a five (5) bedroom, three (3) and half bathroom home with a kitchen/dining area, living room and attached two (2) car garage. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) residents of which (6) can be non-ambulatory residents and six (6) may be bedridden resident. The facility has six (6) Hospice Waiver. The current census is five (5) residents. LPA Brown was accompanied by Licensee/Administrator Linda Thomas (S1) 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 (CCL). LPA Brown observed no obstructions to outdoor passageways. The facility is maintained at a comfortable temperature. 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 grab bars and non-skid mat or strips in the resident bathrooms. There was a designated storage space for resident/staff files. The facility has a locked medication room where residents medications are stored. Also, LPA Brown observed a complete first aid kit maintained and readily available at the facility and first aid books. To add to that, LPA Brown measured and observed the water temperatures in the bathroom to be at 112 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, infection control plan, Labor Laws and the disaster plan were posted in a common area. ***Continuation in LIC809C *** Food Service: Seven (7) days of non-perishable and three (3) days perishable food supply observed at the facility. Care & Supervision: The facility has an administrator present in the facility and Staff #2 (S2) as a designee. LPA Brown observed sufficient number of staff to provide care and supervision to the residents in care. Record Review: LPA reviewed five (5) resident files for admission agreements, updated physician reports, pre-admission appraisals, reappraisals and needs and services plans. LPA Brown observed complete physician’s reports, admissions agreements, needs and services plan, pre-admission appraisal however, LPA Brown observed no yearly reappraisal completed for Resident #2 (R2) as required. Deficiency will be issued. LPA Brown reviewed six (6) staff files for First Aid and CPR certification, criminal record clearance, trainings, and health screenings and Tuberculosis (TB) Test result. LPA Brown observed that Staff #2 (S2), Staff #3 (S3), Staff #4 (S4) and Staff #8 (S8) do not have their First Aid Certification their file. Deficiency will be issued. Also, LPA Brown observed Staff #7 (S7) without TB test result/information in S7 file. Moreover, LPA Brown observed Staff #8 (S8) and Staff #7 (S7) did not complete the required six (6) hours of dementia training as required by subdivision (a) of Section 1569.696 before working independently with residents. In addition, LPA Brown observed Staff #2 (S2), Staff #4 (S4) and Staff #7 (S7) and Staff #8 (S8) did not complete the required additional eight (8) hours of dementia training as required by subdivision (a) of Section 1569.626. Deficiencies will be issued. Also, LPA Brown observed Resident #2 (R2) with half bed rail and no record/documentation or written order from R2's physician indicating the need for half bed rail for R2's mobility. Deficiency will be issued. Licensee/Administrator Linda Thomas removed the half bed rail during the visit. LPA Brown also observed no record of earthquake drill completed at the facility. Deficiencies will be issued. Furthermore, LPA Brown observed Staff #3 (S3) working at the facility without criminal background clearance transfer. Deficiency and civil penalty of $500.00 will be issued during the facility visit today and will continue to be assessed of $100.00 per day until corrected. Licensee/Administrator Thomas transferred S3 criminal background to the facility during the visit. Medications/Medication Administration Records (MAR) records were audited and appeared to be dispensed appropriately by staff members. An exit interview was conducted where this report (LIC809), LIC809D, LIC421BG and Appeal Rights were discussed and provided to Licensee/Administrator Linda Thomas