Routine inspection·December 8, 2023

Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Caregiver Amelia Rodriguez and was granted entry to the facility. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for a capacity of six (6) non-ambulatory residents. The current census is six (6) residents. LPA was accompanied by Caregiver to conduct a general overall inspection, which included, but was not limited to, the following: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to interior and exterior passageways. The facility provides care to residents with dementia which requires auditory alarms on the facility exit doors. The facility will be issued a deficiency for not having an auditory alarm on the facility exit door in resident bedroom number one (1). The facility is maintained at a comfortable temperature. LPA 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 observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperature in the bathroom to be at 112.4 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Postings such as the facility license, personal rights, the CCL complaint 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 and staff files. Medications are kept inside the kitchen inaccessible to residents. LPA found that Resident’s R1, R3, R6, and an unknown resident’s medications were being stored in plastic storage containers. The facility will be issued a deficiency for not storing the resident’s medications in the original medication containers. LPA found that the bathroom closet is being used for sleeping arrangements for the facility staff. The bathroom closet contains a bed, a nightstand, and sleeping arrangements for the facility staff. The facility will be issued a deficiency for converting the bathroom closet into a sleeping area for the staff. Food Service: Non-perishable and perishable food supply is sufficient for the residents in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed six (6) residents files for admission agreements, updated physician reports, and needs and services plans. LPA found that Resident R5 does not have physician’s report/medical assessment completed. The physician’s report/medical assessment in R5’s file was blank and not completed by a physician. The facility will be issued a deficiency for not having a physician’s report/medical assessment completed for R5. LPA found that Resident’s R1, R3, and R4 have a qualifying condition that requires an annual physician’s report/medical assessment. Resident R1’s most recent physician’s report/medical assessment was completed on 11/15/2022, Resident R3’s most recent physician’s report/medical assessment was completed on 1/16/2020, and Resident R4’s most recent physician’s report/medical assessment was completed on 12/5/2022. The facility will be issued a deficiency for not having an annual physician’s report/medical assessment was completed for R1, R3, and R4. LPA found that Resident’s R1, R2, R3, R4, and R5 do not have a needs and services plan completed. The facility will be issued a deficiency for not having needs and services plan completed for Resident’s R1, R2, R3, R4, and R5. LPA reviewed three (3) staff files for First Aid/CPR certifications, criminal record clearances, trainings, and health screenings. Based on the observations made during today’s visit, six (6) 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, and LIC811 were discussed and provided to Caregiver Amelia Rodriguez, along with a copy of the appeal rights.