Routine inspection·March 21, 2024

On 03/21/2024 at 09:30 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 was one (1) staff present, and six (6) residents present. House Manager Ahmed Qasim and Administrator Amirra Younes were contacted and informed of the visit. Facility Manager Amirr Younes arrived during the visit. LPA Brown explained the purpose of the visit to Facility Manager Amirr Younes. The facility is a nine (9) bedroom, three (3) bathroom home with a kitchen/dining area, living room, activity room and laundry area. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) residents of which six (6) can be non-ambulatory residents. The facility has two (2) Hospice Waiver. The current census is six (6) residents. LPA Brown was accompanied by Staff #5 (S5) 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). LPA Brown observed no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 71 degrees Fahrenheit. LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, and storage space, lamps and chair. Moreover, LPA Brown observed that bathrooms were clean, and appliances were operating appropriately. LPA Brown observed grab bars and non-skid mat in the resident bathrooms. LPA Brown measured and observed the water temperatures in the bathroom to be at 169.4 degrees F. Deficiency will be issued. House Manager regulated the hot water temperature to 106 degrees Fahrenheit during the visit. LPA Brown observed no night lights maintained in hallways and passages to nonprivate bathrooms at the facility. Deficiency will be issued. House Manager Younes purchased night lights during the visit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCLD complaint poster, Ombudsman poster and the disaster plan were posted in a common area. Moreover, during the tour of the facility, LPA Brown observed knives drawer not locked in the kitchen, accessible to residents in care. ***Continuation in LIC809C *** In addition, LPA Brown observed cleaning solutions, bleach in the laundry area and readily accessible to residents in care. Also, LPA Brown observed cleaning solutions, bug killers stored under the bathroom sink, readily available to residents in care. Knives cabinet were also observed not locked and knives accessible to residents in care. Deficiency will be issued. House Manager Younes locked the chemicals, cleaning solutions, toxics and knives during the visit. There was a designated storage space for resident/staff files. There is a cabinet with the resident’s medications locked in the medication room. LPA Brown found medications pre-poured for the week for Resident #1 (R1). LPA Brown explained that no medications shall be transferred between containers. Deficiency will be issued. Food Service: Seven (7) days non-perishable and two (2) days perishable food supply observed at the facility. Care & Supervision: The facility has an administrator and house managers. LPA Brown observed sufficient number of staff to provide care and supervision to the residents in care. LPA reviewed three (3) resident files for admission agreements, updated physician reports, and needs and services plans. LPA Brown observed Resident #2 (R2) does not have Pre-Admission Appraisal. Deficiency will be issued. Also, LPA Brown observed no updated Physician Report (LIC602) for Resident #3 (R3), last LIC602 Physician signature date's 01/07/2006. Deficiency will be issued. LPA Brown observed no staff files available to review for Staff #5 (S5), Staff #6 (S6) and Staff #7) for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test result. Deficiencies will be issued. Furthermore, LPA Brown obtained information that two (2) adult individuals were living at the ground floor of the two (2) storey house at the back of the facility. Per documents review, the two (2) individuals reported don't have criminal background clearance and have been living at the facility since 01/05/2024. Deficiency will be issued and civil penalty of $500.00 per individual will be assessed during today's visit and will continue to be assessed of $100.00 per day, per individual until corrected. Medication Audit were completed for three (3) residents. LPA Brown observed that Staff #5 (S5) dispensing Resident #1, Resident #2 and Resident #3 medications and not updating R1, R2 and R3 Medication Administration Record (MAR) per physician's directions. Deficiency will be issued. Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, Chapter 8 of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), LIC809D, LIC421BG and Appeal Rights were discussed and provided to House Manager Amirr Younes.