Routine inspection·November 15, 2024

On 11/15/2024 at 08:45 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 and was granted entry to the facility. At the time of the visit there were two (2) staff present, and five (5) residents present. Licensee/Administrator Thomas Uata was contacted and informed of the visit. Staff #3 (S3) informed Facility Manager Brandee Geurkink of the visit. LPA Brown explained the purpose of the visit to Facility Manager Brandee Geurkink. The facility is a Residential Care Facility for the Elderly (RCFE). The facility is a four (4) bedroom, three (3) bathroom home with a kitchen/dining area, two (2) living room areas, laundry room and an attached two-car garage. The facility is licensed for a capacity of six (6) non-ambulatory residents. The current census is five (5) residents. LPA Brown was accompanied by Facility Manager Geurkink 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 interior and exterior 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, and storage space. However, LPA Brown observed insufficient lighting on resident bedrooms to ensure the comfort and safety of residents at the facility. Deficiency will be issued. Also, LPA Brown observed no chairs provided on resident bedrooms. Technical Violation will be issued. Moreover, LPA Brown observed that bathrooms were clean, and appliances were operating appropriately. LPA Brown observed sufficient furniture throughout the facility. LPA Brown measured and observed the water temperature in the residents shared bathroom to be at 106.8 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Postings such as the facility license, personal rights, the CCLD complaint poster, ombudsman poster, labor laws, and the disaster plan were posted in a common area. ***Continuation in LIC809C*** Cleaning supplies were kept inaccessible to residents in care, however, LPA Brown observed one (1) sharp scissor and two (2) sharp peelers in the kitchen drawer, not locked and accessible to residents in care. Deficiency will be issued. To add to that, LPA Brown did not observe night lights maintained in hallways and passages to non-private bathrooms. Deficiency will be issued. During the tour of the facility, LPA Brown observed that the facility does not have the required emergency supplies, emergency food and emergency water. Deficiency will be issued. There was a designated storage space for resident/staff files. Medications are kept in the medication room. LPA Brown observed he facility is clean and in good repair for residents in care. Food Service : Seven (7) days non-perishable and two (2) days perishable food supply observed at the facility. Care & Supervision : Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Also, LPA Brown noted that there's a staff scheduled to work the night shift as required for facility with dementia residents. Record Review : LPA Brown observed Infection Control Plan, dementia care plan and the required updated liability insurance maintained at the facility. Also, LPA Brown reviewed three (3) resident files for admission agreements, updated physician reports, pre-placement appraisals, needs and services plans and centrally stored medication list. LPA Brown observed missing Resident/Responsible Party Signature and Signature Date and Licensee or LIcensee's designated Representative Signature and Signature date in Resident #3 (R3) Admission Agreement. Deficiency will be issued. Also, LPA Brown observed that Resident #3 (R3) does not have R3's signature/Responsible Person signature and signature date and Resident #2 (R2) Pre-Admission Appraisal does not have R2's Responsible Person signature date. Deficiency will be issued. LPA reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test results. LPA Brown noted that the files reviewed were complete. Medications/Medication Administration Records (MARs) were audited for three (3) residents and appeared to be dispensed and logged appropriately. 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 Facility Manager Brandee Geurkink.