Routine inspection·November 27, 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 Administrator Maria Aguilar and was granted entry to the facility. The facility is a Residential Care Facility for the Elderly (RCFE). The facility is a three (3) bedroom, two (2) bathroom home with a kitchen/dining area, living room, and an attached garage. The facility is licensed for a capacity of six (6) non-ambulatory residents, one resident (1) can be bedridden. The current census is five (5) residents. LPA was accompanied by Administrator to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating within the capacity approved by Community Care Licensing (CCL). There are no obstructions to interior and exterior passageways. The facility is maintained at a comfortable temperature. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, and storage space. LPA found that Resident R1’s bedroom does not have a working bedroom light. The only light in R1’s bedroom was the closet light. The facility will be issued a deficiency for not having appropriate lighting in R1’s bedroom. The bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture throughout the facility. LPA measured and observed the water temperature in the bathroom to be at 106.3 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, and the disaster plan were posted in a common area. Cleaning supplies, and toxins were kept inaccessible to the residents in care. The lock for the knives under the kitchen counter is not locked and the knives were accessible to the residents in care. The facility will be issued a deficiency for not locking the knives appropriately. There was a designated storage space for resident/staff files. Medications are kept inside the hallway leading the garage inaccessible to residents. The facility has a first aid kit stored in the hallway leading into the garage. 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 five (5) resident files for admission agreements, updated physician reports, and needs and services plans. LPA found that Resident R4 does not have an updated medical assessment/physician report. R4’s most recent medical assessment/physician report is dated 6/24/2020. The facility will be issued a deficiency for not having an updated medical assessment/physician report. LPA found that Resident R2 and Resident R3 do not have a preadmission appraisal. The facility will be issued a deficiency for not having a preadmission appraisal. LPA found that Resident R2 and Resident R3 do not have a needs/services plan. The facility will be issued a deficiency for not having needs/services plans. Medications/MARs records were audited and appeared to be dispensed and logged appropriately. LPA reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA found that Staff S1, Staff S2, and Staff S3 do not have staff files. The facility will be issued a deficiency for not having staff files. LPA found that S1, S2, and S3 do not have CPR certifications. The facility will be issued a deficiency for not having CPR certifications. LPA found that Staff S1 has been working at the facility for six (6) months without a criminal record clearance. Staff S1 admitted to LPA that for the past six (6) months they have been at the facility two (2) to three (3) times a week assisting the residents and helping S3 assist with the residents. The facility will be issued a deficiency for allowing S1 to work at the facility without a criminal record clearance. The facility will be issued a five (5) hundred-dollar civil penalty for allowing S1 to work at the facility for six (6) months without a criminal record clearance. Based on the observations made during today’s visit, eight (8) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations, along with a five (5) hundred-dollar civil penalty. An exit interview was conducted, and this report (LIC809), LIC809D forms, LIC811, LIC421BG, and the appeal rights were discussed and provided to Administrator Maria Aguilar.