Routine inspection·November 26, 2024

On 11/26/2024 at 08:50 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 Licensee/Administrator Mariela Aragon and was granted entry to the facility. At the time of the visit there were two (2) staff present, and four (4) residents present. LPA Brown explained the purpose of the visit to Licensee/Administrator Aragon. The facility has six (6) bedrooms, in which three (3) bedrooms are designated for residents, and three (3) bedrooms are designated for staff/family, three (3) bathrooms, living room, kitchen, dining area, backyard, and attached garage. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for a capacity of four (4) non-ambulatory residents and of which two (2) residents may be bedridden. The current census is four (4) residents. The facility has approved hospice waiver for three (3) residents. LPA Brown was accompanied by Licensee/Administrator Aragon 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). The buildings and grounds were free from hazards. Outdoor and indoor passageways were kept free of obstruction. LPA observed an in-ground pool in the backyard, the perimeter of pool is gated and locked. The facility is maintained at a comfortable temperature of 72 degrees Fahrenheit. 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 shared bathroom to be at 128.1 degrees Fahrenheit. Deficiency will be issued. Also, LPA Brown noted no night lights maintained in hallways and passages to non private bathrooms. Deficiency will be issued. Moreover, LPA Brown observed one (1) window screen in disrepair. Technical Violation will be issued. ***Continuation in LIC809C*** The facility is equipped with operating smoke detectors and carbon monoxide alarms. In addition, LPA Brown observed auditory signal that's loud enough to summon staff at the facility. Postings such as the facility license, personal rights, the CCLD complaint poster, ombudsman poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. Medications are kept inside the medication cabinet in the kitchen inaccessible to residents. 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. LPA Brown observed that there's a staff scheduled to work the night shift as required for facility with dementia residents. Record Review : LPA Brown observed the facility's Infection Control Plan and updated Liability Insurance maintained at the facility. Emergency supplies, food, water were observed at the facility. However, LPA Brown noted that the facility's Emergency Plan (LIC610E) was not reviewed annually, without Licensee's signature and date as evidenced of last signature date observed on form LIC610E was 07/05/2019 . Deficiency will be issued. Furthermore, LPA Brown reviewed two (2) resident files for admission agreements, updated physician reports, pre-placement appraisals, Centrally Stored Medication List and Needs and services plans. The files reviewed were complete. LPA reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test results and LPA Brown observed that files reviewed were complete. LPA Brown audited two (2) residents medications and LPA Brown observed that staffs at the facility are not assisting Resident #1 (R1) with one (1) medication and Resident #2 (R2) with one (1) medication per their physician's order as evidenced of discrepancies noted in actual quantity of the medications per their centrally stored medication list. Deficiency will be issued. 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) was discussed and provided to Licensee/Administrator Mariela Aragon.