Routine inspection·March 18, 2024

Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced annual required visit . LPA was granted entry and met with caregiver Leondro Valenzuela who was informed of the purpose of the visit. Licensee Ellery Jane arrived during LPA's visit. At the time of the visit there was two (2) staff and six (6) residents present. The facility has a hospice waiver for six (6) residents. A dementia program is also on file. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted interviews. LPA observed the following: 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 residents. LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. Facility contained PPE equipment and cleaning supplies to do regular cleaning of the facility. Cleaning supplies and detergents were locked and inaccessible to residents. The sharp and dangerous objects was locked and inaccessible to residents. Facility sketch, exit routes, personal rights, complaint information and emergency phone numbers were found posted in the facility. The smoke detector and carbon monoxide was operational, and the hot water temperature was recorded at 108 degree F, which met department requirements. Facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. LPA reviewed two (2) staff files and training. All staff have the required personnel records on file and criminal record clearance and updated training along with CPR/First Aid Certification. The listed administrator possesses a current administrator's certificate. Six (6) resident files were reviewed, and possessed all required paperwork that included Admissions Agreement, Physician's Report, and Needs and Service Plan. LPA's record review of the resident files revealed Resident One (R1) Physician Report on file was last dated on 03/25/2022. Licensee did not have an updated Physician's Report for R1. Residents diagnosed with Dementia must have an updated Physician's Report completed annually. A deficiency cited under Title 22 Regulation 87705(c)(5) Care of Persons with Dementia will be issued along with a plan of correction. Resident medication was centrally stored and locked in a cabinet in the dining room area. LPA reviewed medications for four (4) residents and found all medication listed on MARs and all required labeling was found to be in place. LPA reviewed the facility's emergency and disaster plan. LPA observed all facility exits were clear from obstructions. LPA observed emergency supplies in the garage and first aid kit with all required items. Fire extinguishers were fully charged and inspected. No deficiencies were cited at the time of the visit. An exit interview was conducted where a copy of this report, LIC 809-D, appeal rights, and technical assistance was provided to Licensee Ellery Jane.