Routine inspection·September 21, 2024

On 09/21/2024 at 11:15 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 two (2) staffs present, and six (6) residents present. LPA Brown met with Administrator Dominic Garcia and LPA Brown informed Administrator Garcia of the purpose of the visit. Administrator Garcia left during the visit due to personal appointment. Administrator Garcia authorized Staff #4 (S4) to receive and sign the reports of the visit today. LPA Brown explained the purpose of the visit to Staff #2 (S2) and S4.. The facility is a five (5) bedroom, three (3) bathroom home with a kitchen/dining area, living room, laundry area and attached three (3) car garage. 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 where one (1) may be bedridden. The facility has six (6) Hospice Waiver. The current census is six (6) residents. LPA Brown was accompanied by S2 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 74 degrees Fahrenheit. LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, lamps and storage space. LPA Brown observed sufficient lightning. Moreover, LPA Brown observed that bathrooms were clean, and appliances were operating appropriately. LPA Brown measured the hot water at residents shared bathroom and LPA Brown observed 108 degrees Fahrenheit. LPA Brown observed grab bars and non-skid mat in the resident bathrooms. ***Continuation in LIC809C *** Also,LPA Brown observed Resident #2 (R2) has half bed rails. But per documents review and staff interview, R2 does not have a written order from R2 physician indicating the need for half bed rail for mobility. Deficiency will be issued. Moreover, LPA Brown observed sufficient furniture and lighting throughout the facility. 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 Emergency Disaster plan were posted in a common area. Furthermore, LPA Brown observed Emergency Food and Water at the facilities. Food Service : Seven (7) days non-perishable and three (3) days perishable food supply observed at the facility. Care & Supervision : The facility has a certified administrator. However, LPA Brown observed no sufficient number of staff to provide care and supervision to the residents in care as there's no staff scheduled to work the night shift, awake and on duty as required for facility with dementia residents. Deficiency will be issued. Record Review : LPA Brown observed no liability insurance at the facility. Deficiency will be issued. LPA Brown observed no emergency - fire or earthquake drill conducted at the facility at least quarterly. Deficiency will be issued. LPA Brown reviewed four (4) resident files for admission agreements, updated physician reports, pre-placement appraisal, centrally stored medication list and needs and services plans. LPA Brown observed Resident #1 (R1), Resident #2 (R2) and Resident #3 (R3) have physician report but R1, R2 and R3's physician report do not have the required physician signature and signature date. Deficiency will be issued. In addition, LPA Brown observed Resident #1 (R1), Resident #2 (R2), Resident #3 (R3) and Resident #4 (R4) have Admission Agreement in their facility file but the required signature page were not complete or missing and other pages are also missing. Deficiency will be issued. LPA Brown reviewed four (4) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test results. LPA Brown observed that documents reviewed were complete. An exit interview was conducted where this report (LIC809), LIC809D, and Appeal Rights were discussed and provided to staff Lizette Alvarez.