Routine inspection·March 11, 2024

Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced annual required visit . LPA was granted entry and met with Administrator Kristine Mangente, who was informed of the purpose of the visit. At the time of the visit there was three (3) staff and six (6) residents present. The facility is licensed for six (6) non-ambulatory residents, of which two (2) may be bedridden. The facility has a hospice waiver for six (6) residents. A dementia program is also on file. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted interviews. LPA observed the following: Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. LPA observed outdoor furniture and shaded area for residents. LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. Facility contained PPE equipment and cleaning supplies to do regular cleaning of the facility. Cleaning supplies and detergents were locked and inaccessible to residents. The sharp and dangerous objects was locked and inaccessible to residents. Facility sketch, exit routes, personal rights, complaint information and emergency phone numbers were found posted in the facility. The smoke detector and carbon monoxide was operational, and the hot water temperature was recorded at 108 degree F, which met department requirements. 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. LPA reviewed three (3) staff files and training. All staff have the required personnel records on file and criminal record clearance and updated training along with CPR/First Aid Certification. Six (6) resident files were reviewed, and possessed all required paperwork that included Admissions Agreement, Physicians Report, and Needs and Service Plan. The listed administrator possesses a current administrator's certificate. LPA observed the centrally stored medication cabinet to be unlocked and accessible to residents in care. A deficiency cited under Title 22 Regulation 87465(h)(2) Incidental Medical and Dental will be issued along with a plan of correction. LPA reviewed medications for six (6) residents and found medication listed on MARs was found to be in place. LPA reviewed the facility's emergency and disaster plan. A technical assistance (TA) will be issued under Healthy and Safety Code 1569.695(c) due to quarterly fire drill required to be conducted by the end of the March 2024. LPA observed all facility exits were clear from obstructions. LPA observed emergency supplies in the garage and first aid kit with all required items. Fire extinguishers were fully charged and inspected. An exit interview was conducted where a copy of this report, LIC 809-D, and appeal rights was provided to Mangente.