Routine inspection·July 24, 2023

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct an annual inspection. LPA Moleski met with facility administrator Angelita Dayoan and explained the purpose of the visit. LPA Moleski reviewed three resident files (R1-R3) and three staff files (S1-S3). S2's health screening report did not indicate that a chest x-ray or tuberculosis skin test were performed. LPA Moleski reviewed medication storage and medication administration records (MARs) for R4. LPA Moleski counted 18 signed administrations of a medication which had been filled in a 14-count bottle. Dayoan said a staff member signed the MAR when doses were not, in actuality, given. LPA Moleski toured the facility with Dayoan and inspected common areas, the kitchen, bedrooms, bathrooms, and backyard areas. Furniture and furnishings were sufficient to meet the needs of residents. While inspecting a resident bedroom, LPA Moleski observed a bed bug shell present on a resident's bed. On another bed in the same room, LPA Moleski observed spotting on a pillowcase. LPA Moleski photographed the shell and the spotting. The facility temperature was 75 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's water temperature measured 109 degrees Fahrenheit, which is within the required range of 105 and 120 degrees. [continued on 809-C] LPA Moleski observed first aid supplies, a fully-charged and up-to-date fire extinguisher, and working carbon monoxide/smoke detectors. LPA Moleski observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA Moleski observed a locked cabinet for the storage of medication. LPA Moleski observed locked cabinets for the storage of cleaning solutions and knives. LPA Moleski interviewed two staff members (S1-S2) and two residents (R3-R4). This facility is being cited per 22 CCR Sections 87411(f), 87465(a)(4) and 87303(a). An exit interview was held with Dayoan. Appeal rights and a copy of this report were left with Dayoan.