Routine inspection·July 22, 2024

On 07/22/2024 at 12:05 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 Annie Jane Mikenas arrived at the facility during the visit. At the time of the visit there were three (three) staff present, and five (5) residents present. The facility is a five (5) bedroom, two & half (2 & 1/2) bathroom home with a kitchen/dining area, living room/activity room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) bedridden residents, serving mentally disabled seniors. The facility’s approved for six (6) hospice waiver. The current census is five (5) residents. LPA Brown was accompanied by Staff #2 (S2) 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. 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 sufficient furniture and lighting throughout the facility. LPA Brown measured and observed the water temperatures in the bathroom to be at 110 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Fire extinguishers were also observed at the facility. Posters such as personal rights, the CCLD complaint poster, labor laws, and the disaster plan were posted in a common area. Furthermore, LPA Brown observed the den converted to staff room. Deficiency will be issued. ***Continuation in LIC809C *** Sharps, and other dangerous items were kept inaccessible to residents in care. However, LPA Brown observed two (2) gallons of chemicals inside the shed at the backyard, not locked, and accessible to residents in care. Deficiency will be issued. There was a designated storage space for resident/staff files. There is a Medicine Cabinet with the resident’s medications locked. LPA Brown observed incomplete first aid kit. No bandages or roller of bandages in the facilty's first aid kit. Deficiency will be issued. Also, no First Aid Manual approved by the American Red Cross, the American Medical Association or a state federal health agency at the facility. Deficiency will be issued. 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 during the visit. However, LPA Brown observed insufficient staff to cover night shift as required for facilities with dementia residents. Deficiency will be issued. Record Review : LPA Brown reviewed three (3) resident files for admission agreements, updated physician reports, and needs and services plans. LPA Brown observed resident files reviewed were complete. LPA Brown reviewed four (4) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with Tuberculosis (TB) test result. LPA Brown found that one (1) of the four (4) staff do not have Health Screening Report on file. Deficiency will be issued. Also, three (3) of four (4) staff do not have TB completed and no TB Test Result on File. Deficiency will be issued. Furthermore, LPA Brown observed no required trainings provided to Staff #4. Deficiency will be issued. Medications/Medication Administration Record (MAR) were audited for three (3) residents, and LPA Brown observed no issue. 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 forms, and Appeal Rights were discussed and provided to Licensee/Administrator Annie Jane Mikenas.