Routine inspection·July 20, 2023

On 7/20/2023, at 10:25 a.m., Licensing Program Analyst (LPA) Janette Romero arrived unannounced at the facility to conduct an annual required visit. LPA was greeted and granted entry by Caregiver, Arvin Valenciano who was informed of the purpose of visit. At the time of visit there was five (5) residents, and two (2) staff present. The facility is approved to care for six (6) non-ambulatory residents and has a dementia program along with a hospice waiver for two (2). Facility has a bedridden fire clearance for six (6) residents. LPA toured the facility inside and out with Caregiver Valenciano. During the visit, LPA observed the following: Kitchen: LPA observed kitchen to be clean. Food is stored in a safe and healthful manner. Utensils and dishware are sufficient for the approved capacity. LPA observed food supply met the requirement for a two-day supply of perishable food and seven-day supply of non-perishable food. Sharps are secured in a locked kitchen drawer. Dining and Livingroom: LPA toured the dining and living/family room area. LPA observed area to be clean and furniture in good condition. Hallway : LPA toured the hallway and observed hallway to be clean with no pathway obstruction. Carbon monoxide & smoke detector were tested and functioning properly. Fire extinguisher is charged and up to date. Records: Staff present possess criminal background clearance and association to the facility. Administrator’s certificate expires on 10/18/2023. Continued on LIC809-C.. Continued from LIC809. Centrally Stored Medications: LPA observed a first aid kit with required components. Medications were secured in a kitchen cabinet. LPA reviewed physical medications for the residents as well as the Medication Administration Record (MAR) used to log administration of residents’ medications. LPA discovered the MARs was not signed/noted for medication refusal from 7/15-20/2023. Caregiver Valenciano stated he assisted residents with medication for the past five days but forgot to initial the MARs. Deficiency cited. Bedrooms : Client bedrooms were each furnished with a bed, chair, closet, clothing storage and lighting. Bathrooms: Bathrooms have a working toilet, wash basin, and were equipped with a grab bar in the shower. The hot water temperature measured at 116- and 118-degrees Fahrenheit. The facility has clean towels, blankets, and linen, available in different colors for the residents in care. Garage/Laundry : LPA observed laundry room and garage to be clean. Washing machine and dryer are all in good repair. Laundry detergent was observed to be secured in locked laundry room. Yard/Outside Area: Covered patio seating is available for the residents in care. A gate/wood wall secured the entire backyard. All outdoor pathways were free of obstructions. No bodies of water were observed. There were no firearms or ammunition observed at the facility, and LPA was informed the facility will not store firearms or ammunition on the premises. Due to discrepancies in MARs log, LPA cited a deficiency faulting the facility. Deficiency noted on LIC809-D. An exit interview was conducted, and a copy of this report was reviewed and provided to Caregiver Valenciano along with LIC809-D and Appeals Rights.