Routine inspection·October 19, 2023

On 10/19/2023, Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA was granted entry and met with Administrator, Vivian Reyes, who was informed of the purpose of the visit. At the time of the visit there was (2) staff and (6) residents present. The facility is a one story home with (4) bedrooms and (2) bathrooms. No pools or firearms are present. The residents served are elderly ages 60 and above. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted a staff and resident interviews. LPA observed the following: Infection Control: The LPA observed hand washing stations with hand hygiene supplies. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. The facility has a plan to train and follow infection control guidelines. Physical Plant: Physical plant was observed to be clean and in good repair. The indoor and outdoor areas were observed to be free of hazards. Laundry equipment was observed to be in good working condition. The sharp and dangerous objects were observed to be locked and inaccessible to residents. The smoke detector and carbon monoxide was operational, and the hot water temperature was recorded at 105.4F. Food Service: LPA observed 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. Record Review and Resident/Staff Files: LPA reviewed (2) staff files and training. All staff have criminal clearance and updated training along with CPR/First Aid Certification. The listed administrator has a current administrator's certificate. Resident files were reviewed and possessed all required paperwork. Health Related Services/ Incidental Medical Services: The following issues will be cited. Based on interview with Administrator and records review, this PRN was not authorized by Resident 1 (R1)'s primary care physician. The facility currently has a waiver for three (3) hospice residents, however based on interview with administrator the facility currently has (5) residents on hospice. The administrator stated they sent a waiver increase letter that was sent to the department but was unable to provide a copy during the visit. According to California Code of Regulations Title 22, a licensee shall not retain a hospice resident without first securing a hospice waiver from the department. Plans of correction were created with the administrator for these deficiencies. Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. The last fire drill was conducted 7/18/23, the facility is due for another fire drill this month. LPA will document Technical advisory note and administrator agreed to hold fire drill by 10/31/2023. LPA observed emergency exits and emergency supplies. The licensee currently has not paid their annual fees. The administrator was able to show proof of sending a payment 8/23/2023. LPA provided balance information and how the payment can be made or disputed with the department. An exit interview was conducted where a copy of this report, along with LIC809-D page, and appeal rights were provided to Administrator, Vivian Reyes.