Routine inspection·December 27, 2023

On 12/27/2023 at 9:45am, Licensing Program Analyst (LPA) Arvin Villanueva conducted an unannounced annual required visit, with the use of the CARE Inspection Tool. LPA initially met with a staff on duty and explained the purpose of today’s visit. The facility administrator, Angelita Dayoan, was informed of the visit and arrived shortly after. The facility is currently licensed to serve 6 non-ambulatory elderly residents of which 1 may be bedridden. The facility is approved for 4 hospice residents. Currently, the facility has 3 hospice residents in care. Room #4 is cleared for bedridden residents. Present during this visit, there were 6 residents in care with 2 staff on duty. At 10.15am LPA inspected the facility’s physical plant with the administrator including but not limited to the kitchen, dining room, resident bedrooms, resident bathrooms, laundry room, living area, common TV area, and outside of the facility to ensure compliance with Title 22 regulations. The facility is a one-story structure located in a residential neighborhood. There were no bodies of water on the premises. Outside of the facility was observed to be cleaned and clear of obstructions. Additionally, LPA observed outdoor furniture for residents’ use and covered area for outdoor activities. Entrance, exits and hallways were observed to be clear of obstructions. LPA observed 6 private resident bedrooms and 3 bathrooms for resident use. One of the bedrooms has its own bathroom. LPA observed beds and bedding supplies were in good condition, adequate lighting was provided, and sufficient storage for the resident's personal belongings. Bed linens, comforters, and bath towels were adequately stocked during the visit. Bathrooms were operational and adequately supplied including with grab bars and non-skid flooring. {Con't LIC809-C} {Con't from LIC809} LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were locked and not accessible to residents in care. The kitchen was inspected, and sufficient 2-day perishable and 7-day non-perishable food was maintained adequately. Room temperature was maintained in the facility at 72 degrees F. Water temperature in one of the bathroom was measured at 115 degrees F. All 3 fire extinguishers were serviced on 8/11/2023. Smoke detectors and carbon monoxide were tested and found to be operable during this visit. Medication storage area was observed to be locked and inaccessible to residents in care. Medications were reviewed for accuracy. First aid kit was observed to have adequate supplies and accessible to staff. The facility maintains for each resident Centrally Stored Medication, Destruction Record and PRN Log. LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed personal rights, resident council and complaint information posted. Facility has appropriate internet access available for resident use. LPA observed facility’s sufficient equipment and supplies to meet activity program needs of residents in care. During this inspection, LPA conducted an audit of facility files, 6 resident files, and 4 staff files for regulatory compliance. All staff noted on LIC 500 have criminal background clearances and associated to this facility. LPA attempted 2 resident interviews and 2 staff interviews. 6 out of 6 Resident files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required. 4 out of 4 staff files reviewed contained all required contents including health screening, TB results, current first aid/CPR, and initial and ongoing required trainings. Facility’s liability insurance is current per regulatory requirements. The facility is current on annual license fees. LPA reviewed facility’s disaster plan to ensure regulatory compliance. Facility conducts quarterly fire drills. LPA requested an updated copy of current liability insurance, LIC 308 and LIC 500. Due to insufficient time, this annual will require a continuation visit. The Department will return at a later date to complete the annual inspection. An exit interview was held with Angelita Dayoan, Administrator, and a copy of this report was provided to the facility.