Routine inspection (multi-day)·December 24, 2024

Licensing Program Analyst (LPA) Arvin Villanueva conducted an unannounced Case Management - Annual Continuation visit today at the facility to continue with the Annual visit initiated on 12/20/2024. LPA met with staff on duty and explained the purpose of the visit. The Administrator, Angelita Dayoan, was notified and arrived shortly after. Present during today's visit were 6 residents in care with 2 staff on duty. The LPA continued with facility visit to ensure facility is in compliance with Title 22 Regulations. Facility is fire cleared for 6 non-ambulatory residents and one room, located near the front entrance of the facility was fire cleared for bedridden use. Review of 3 resident files (R1, R2, R3) which include review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. During the record review, it was noted that a resident (R1) had been assessed by a physician (per LIC602 dated 7/17/24) as bedridden and was observed in a bedroom that had not been approved for bedridden use. A Technical Advisory on this issue had already been provided to the Licensee during the previous annual visit on 12/27/23. Medication review of 3 residents (R1, R2, R3) include review of physician orders for over-the-counter medications. TA was provided to ensure resident physicians indicate residents' capacity to determine the need for PRN medication. Review of 4 staff files (S1, S2, S3, S4) which include review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. No issues were noted at this time. Facility conducts quarterly disaster drill and last drill was on 11/16/24. Facility has a dementia and infection control plan. Administrator provided the following documents during this visit: current Liability Insurance Certificate, LIC 610E, LIC500 and LIC308 to the Department. This facility is hereby cited per 22 CCR Sections 87202(a)(2). An immediate civil penalty in the amount of $500 is hereby assessed due to a violation of fire clearance. Exit interview was conducted and a copy of this report and appeal rights were provided.