Routine inspection·November 13, 2024

On 11/13/2024 at 11:45 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 were three (3) staff present, and four (4) residents present. Licensee/Administrator Nimfa Ramos was informed of the visit. LPA Brown explained the purpose of the visit to Licensee/Administrator Ramos. The facility is a six (6) bedroom, four (4) bathroom home with a kitchen, two (2) dining areas, two (2) living rooms, and an attached garage. The facility is a Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) non-ambulatory residents and one (1) resident may be bedridden. The current census is four (4) resident. LPA Brown was accompanied by Licensee/Administrator Ramos 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 interior and exterior passageways. 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, nightstands, 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/staffs shared bathroom to be at 110 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Postings such as the facility license, personal rights, the CCLD complaint poster, ombudsman poster, labor laws, 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. Overall, the facility is clean, in good repair for residents in care. ***Continuation in LIC809C*** 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. Record Review : LPA reviewed two (2) resident files for admission agreements, updated physician reports, pre-placement appraisals, needs and services plans and centrally stored medications list. LPA Brown observed Resident #2 (R2) Pre-Admission Appraisal was incomplete as evidenced of no resident/responsible person signature and licensee/facility representative signature. Deficiency will be issued. LPA Brown observed incomplete Resident #2 (R2) Preplacement Needs & Services Plan (LIC625) as evidenced of no resident/responsible person signature noted in R2 form LIC625. Deficiency will be issued. LPA reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test results. LPA Brown observed Staff #3 (S3) did not complete the required training in First Aid from persons qualified by such agencies as the American Cross. Deficiency will be issued. In addition, LPA Brown observed that the facility admitted two (2) bedridden residents on 08/25/2024 and per R1 and R2 Admission Agreements and Physician Reports (LIC602) and documents review, the facility's licensed for one (1) bedridden resident. Deficiency will be issued and a immediate civil penalty of $500.00 will be issued today for zero tolerance violation. During Medication Audit, LPA Brown observed that staffs at the facility are not assisting Resident #1 (R1) with R1's one (1) medication per R1's Physician Order as evidenced of R1's one (1) medication was missing. 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), LIC809D, LIC421IM and Appeal Rights were discussed and provided to Licensee/Administrator Nimfa Ramos.