Health check·April 24, 2024

On 4/24/24, at 10:45am, Licensing Program Analyst (LPA) Arvin Villanueva arrived to this facility unannounced to conduct their quarterly case management visit. LPA met with the facility administrator, Annie Lyn Rodriguez and explained the purpose of the visit. During today's visit, 4 residents in care were present with 2 staff on duty. Facility is approved for 6 non-ambulatory elderly residents, fire cleared for 1 bedridden resident, and approved for 1 hospice resident. LPA observed the current stipulation order place in a conspicuous place in the front area of the home at the office desk. LPA toured the physical plant of the facility. During this visit, all residents were in their bedrooms. 4 of 5 resident bedrooms were observed to be cleaned and free of obstruction. One resident bedroom was not observed due to resident sleeping during the tour. The room temperature was observed to be at 71 degrees F. All 3 bathrooms were observed to be clean and free of clutter. Hot water temperature in the hallway bathroom was measured at 114 degree F. During the tour of the kitchen, LPA observed 2 resident medications were stored in the kitchen refrigerator, which are unlocked and accessible to resident in care. LPA observed the administrator, Annie Lyn Rodriguez, immediately placed the medications in a small refrigerator and placed it in a locked room marked "staff room" in the kitchen area. Other medications are located at the office area and were observed to be properly stored, locked and inaccessible to resident in care. A technical advisory was also provided to the administrator to obtain and place a thermometer inside the freezer and refrigerator to ensure regulatory temperature is maintained at all times. Con't to LIC809 The outdoor area was observed be free of clutter and obstructions. There is a freezer outside the covered patio at the back area of the facility. LPA observed the side gate, located at the right side of the facility, to not work properly as the bottom is stuck on the ground and LPA used a bit of force to open the gate. Technical advisory was provided to the administrator to repair the issue. The back storage was observed to be unlocked. Inside the storage, LPA did not observed sharp or dangerous objects. However, technical advisory was still provided to the administrator to lock the storage as a precaution. Through resident file review, it was discovered that 2 of 5 residents' LIC 602A was signed by nurse practitioners, in place of physicians. Technical advisory was provided to the administrator to submit a waiver request for non-physicians to sign residents' medical assessments and prescriptions. LPA reviewed 3 staff files. All 3 staff have current 1st aid/CPR certificates. Monthly training as per stipulation is conducted on a monthly basis. Last training was conducted on 3/4/2024. All deficiencies are cited from the California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8 ; and the Health and Safety Code 1569.38 Residential Care Facilities on the LIC 809-D. If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed. Exit interview conducted with Annie Lyn Rodriguez and a copy of this report and appeal rights were provided.