Routine inspection·April 1, 2025

On 04/01/2025 at 11:38 AM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct the required comprehensive annual inspection. LPA Brown met with a staff and was granted entry to the facility. Licensee/Administrator Mary Grace Trias was informed of the visit. LPA Brown informed Licensee/Administrator Trias of the purpose of the visit. At the time of the visit there were two (2) staff present, and three (3) residents present. The facility is a four (4) bedroom, three (3) bathroom home with a kitchen/dining area, living room/activity room, laundry room and an attached garage. 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 one (1) may be bedridden. The facility’s approved for six (6) hospice waiver. The current census is four (4) residents. LPA Brown was accompanied by Licensee/Administrator Trias 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 70 degrees Fahrenheit (F). 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 residents bathroom to be at 112.8 degrees F. The facility is equipped with operating combined smoke detectors and carbon monoxide alarms. Charged fire extinguisher was also observed at the facility. Posters such as personal rights, the CCLD complaint poster, Ombudsman poster, and the disaster plan, House Ruled and Visitation Policy were posted in a common area. ***Continuation in LIC809C *** However, LPA Brown noted that the facility did not review the Emergency Disaster Plan (LIC610D) annually and no Licensee or Administrator signature and signature date. Deficiency will be issued. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There's a designated storage space for resident/staff files. There is a medicine cabinet with the resident’s medications locked. LPA Brown observed the complete first aid kit however, no first aid book observed at the facility. Deficiency will be issued. Moreover, LPA Brown noted that the facility has the required emergency supplies, emergency food and emergency water maintained. 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. However, LPA Brown observed that the facility does not have a staff scheduled to work the night shift, awake and on duty as required for facility with dementia residents that are reported by their physician in Physician Report (LIC602) with sun downing or wandering behavior. Deficiency will be issued. Record Review : LPA Brown noted that the facility has an updated Infection Control Plan and updated Liability Insurance. LPA Brown reviewed four (4) resident files for admission agreements, updated physician reports, pre-placement appraisals, centrally stored medication list/physician orders and needs and services plans. LPA Brown observed resident files reviewed were complete. In addition, LPA Brown noted that Resident #2 (R2) half bed rail has written orders from R2's physician indicating the need for half bed rail for mobility. 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 that Staff #1 (S1) First Aid/CPR Certification expired on 03/2025. Deficiency will be issued. However, Licensee/Administrator Trias informed LPA Brown that no trainings were provided by the two (2) Hospice Agencies to facility staffs for implementation of the hospice care plan. Deficiency will be issued. During medication audit, LPA Brown observed that staffs at the facility are assisting their residents with their self-administered medication per their doctor's order. No issues observed. Based on the observations made during today’s visit, deficiencies and technical assistance were cited per Title 22, Division 6, Chapter 8 of the California Code of Regulations (CCR). An exit interview was conducted, and this report (LIC809), LIC809D, LIC9102 and Appeal Rights were discussed and provided to Licensee/Administrator Mary Grace Trias.