Routine inspection·February 8, 2024

On 02/08/2023 at 09:30 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. Administrator Cristina Fajardo was contacted and arrived at the facility during the visit. At the time of the visit there were fifteen (15) residents and six (6) staff present. The facility is an eleven (11) bedroom, and four (4) bathroom home with a kitchen/dining area, living room/activity room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of fifteen (15) ambulatory residents and the current census is fifteen (15) residents. LPA Brown was accompanied by Administrator Fajardo 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 passageway but LPA Brown observed obstructions to outdoor passageways as piles of wood were observed with visible nails hanging located at the backyard of the home. Deficiency will be issued. The facility is maintained at a comfortable temperature. 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. However, LPA Brown observed no reading lamps on Room # 4, Room #5, Room #2, Room #9 and Room #11. Also, LPA Brown observed no chairs in Room # 8, Room #9 and Room #10. Deficiency will be issued. LPA Brown measured and observed the water temperature in the bathroom to be at 108 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Fire extinguishers were also observed at the facility. ***Continuation in LIC809C *** Posters such as labor laws, and the disaster plan were posted in a common area, but LPA Brown observed the personal rights, the CCLD complaint poster and Ombudsman poster were not posted in a common area. Deficiency will be issued. Cleaning supplies, chemicals and other dangerous items were observed not locked at the back area of the facility, making it accessible to residents in care. Deficiency will be issued. Also, LPA Brown observed no activity schedule posted at the facility. Deficiency will be issued. Furthermore, LPA Brown observed no night lights and emergency lightning maintained at the facility. Deficiency will be issued. There was 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. Food Service: More than seven (7) days’ supply of Non-perishable foods and more than three (3) 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 in 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. Record Review: LPA Brown reviewed three (3) resident files for admission agreements, physician reports, pre-placement appraisals, functional capabilities and needs and services plans. LPA Brown observed that Resident #1 (R1), Resident #2 (R2) and Resident #3 (R3) do not have the required pre-placement appraisals, functional capabilities and needs and services plan. Deficiencies will be issued. LPA Brown reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA Brown found that Staff #2 (S2), and Staff #5 (S5) do not have completed Health Screening report with Tuberculosis (TB) Result maintained in their facility file and no required annual trainings were completed by S2 and S5. Also, LPA Brown observed that S2 and S5 do not have the required contiunation/annual training maintained on S2 and S5 facility file and S5 does not have the required initial training. Deficiencies will be issued. Moreover, three (3) residents medications were audited and per review of their Medication Administration Record (MAR), LPA Brown observed two (2) medications for Resident # 1 (R1) were dispensed but R1's MAR was not updated and one (1) medication was dispensed for Resident #3 (R3) and R3’s MAR is not updated. 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 forms, LIC9102 and Appeal Rights were discussed and provided to Administrator Cristina Fajardo.