Routine inspection·February 21, 2025

On 02/21/2025 at 9:34 AM, Licensing Program Analysts (LPAs) Melody Brown and Beena Singh made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Brown and LPA Singh met with Licensee/administrator Mary Libed and was granted entry to the facility. At the time of the visit there were two (2) staff present, and two (2) residents present. LPA Brown and LPA Singh explained the purpose of the visit to Licensee/Administrator Mary Libed. The facility has 7 bedrooms, in which 5 bedrooms are designated for residents, and 2 bedrooms are designated for staff/family, 2 and 1/2 bathrooms, living room, kitchen, dining area, backyard, and attached garage. 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 two (2) residents. The facility has approved hospice waiver for three (3) residents. LPA Singh was accompanied by Licensee/Administrator 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). The buildings and grounds were free from hazards. Outdoor and indoor passageways were kept free of obstruction. The facility is maintained at a comfortable temperature of 75 degrees F.. LPAs inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPAs observed sufficient furniture and lighting throughout the facility. During the tour of the facility, LPAs observed one window and one door screen in disrepair. Technical violation issued. Also, LPAs observed No night lights maintained in hallways and passageways to non-private bathrooms. Deficiency will be issued. ***Continuation on LIC 809C*** LPA Singh measured and observed the water temperature in the residents/staffs shared bathroom to be at 125 degrees F and second bathroom 122 degrees F. Deficiency will be issued. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Postings such as the facility license, personal rights, the CCLD complaint poster, ombudsman 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/staff files. Medications are kept inside the medication closet in the hallway inaccessible to residents. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service : Seven (7) days non-perishable and two (2) days perishable food supply observed at the facility. No Emergency food and emergency supplies. Deficiency will be issued. Care & Supervision : LPAs observed that the facility does not have a staff scheduled to work the night shift, awake and on duty as required for facility with Dementia residents as determined on residents medical assessment/Physician Report (LIC602). Deficiency will be issued. Record Review : LPA reviewed two (2) resident files for admission agreements, updated physician reports, pre-placement appraisals, needs and services plans. The files were complete with updated physician’s reports, admissions agreements. However, pre-admissions appraisals was not completed for Resident#1(R1) and Resident#2(R2). Deficiency will be issued. LPAs reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test results. ***Continuation in LIC809C*** Medications/MARs records were audited and appeared to be dispensed and logged appropriately. Also, LPAs observed facility emergency plan not reviewed, not updated annually, signed and dated. As evidence of disaster plan posted has signature date of 5/27/2021. 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), LIC809C, LIC 809D and Appeal Rights were discussed and provided to Licensee/Administrator Mary Libed.