Routine inspection·April 3, 2025

On 04/03/2025 at 11:30 AM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct the required comprehensive annual inspection. LPA Brown met with a staff and was granted entry to the facility. Licensee/Administrator MIchelle Matamoros was informed of the visit. LPA Brown informed Licensee/Administrator Matamoros of the purpose of the visit. At the time of the visit there were two (2) staffs present, and six (6) residents present. The facility is a six (6) bedroom, three (3) bathroom home with a kitchen/dining area, living room/activity room, laundry room and an attached garage. The facility is Residential Care Facility for the Elderly (RCFE). LPA Brown noted that the pool in the backyard was locked and with the required fenced. The facility is licensed for a capacity of six (6) non-ambulatory residents of which one (1) may be bedridden. The facility’s approved for four (4) hospice waiver. The current census is six (6) residents. LPA Brown was accompanied by Licensee/Administrator Matamoros 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 of 75 degrees Fahrenheit (F). 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 noted that there a non-slip mat in residents' shared bathroom. LPA Brown observed sufficient furniture and lighting throughout the facility.***Continuation in LIC809C *** LPA Brown measured and observed the water temperature in the resident bathroom to be at 113.9 degrees F. The facility is equipped with operating smoke detectors. However, LPA Brown observed no carbon monoxide detector at the facility. Deficiency will be issued. Charged fire extinguishers were also observed at the facility. Posters such as 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's a designated storage space for resident/staff files. There is a medicine cabinet with the resident’s medications locked. LPA Brown observed a complete first aid kit and first aid book at the facility. Moreover, LPA Brown noted that the facility has the required emergency supplies, emergency food and emergency water maintained at the facility. 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 with appropriate and enough hours to appropriately manage the facility. The facility has sufficient number of staff to provide care and supervision to the residents in care. LPA Brown noted that the facility has a staff scheduled to work at night, awake and on duty as required for facility with dementia residents. Record Review : LPA Brown noted that the facility has an updated Infection Control Plan, Emergency Disaster Plan and updated Liability Insurance. LPA Brown reviewed three (3) resident files for admission agreements, updated physician reports, pre-placement appraisals, centrally stored medication list/physician orders and needs and services plans. LPA Brown observed resident files reviewed were complete. However, LPA Brown noted that Resident #2 (R2) has a half bed rail and per records review, R2 does not have written order from R1's physician indicating the need for half bed rail for mobility. Deficiency will be issued. In addition, LPA Brown noted that Resident #3 (R3) has a bed rail that extend fhe entire length of the bed and per interview and records review, the facility does not have an approved exemption for R3's full bed rail. Deficiency will be issued. LPA Brown reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test result. LPA Brown noted that files reviewed were complete. ***Continuation in LIC809C*** During medication audit, LPA Brown observed that staffs at the facility are assisting their residents with their self-administered medication as prescribed by their physician. No issues noted. 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 (CCR). An exit interview was conducted, and this report (LIC809), LIC809D, LIC9102 and Appeal Rights were discussed and provided to Licensee/Administrator MIchelle Matamoros.