Routine inspection·January 9, 2024

On 01/09/2024 at 8:20 PM, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA Lee met with direct care staff, Theodore Patterson. A brief telephone call to administrator Mark Labella was conducted. LPA Lee explained to administrator the purpose of today’s visit. Direct care staff, Theodore Patterson assisted LPA Lee during the visit. LPA Lee explained the purpose of the visit to care staff. Administrator certificate # is 6028860740 and will expire on 07/29/2024. The current census is 8 with 2 facility staff. Administrator was not present during today’s visit. This facility is a two-story building licensed to serve 8 non-ambulatory residents, 2 ambulatory residents in bedroom #5 only and approved for 1 hospice waiver. LPA Lee inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA Lee observed resident 1 (R1) who is non-ambulatory in bedroom #5, which is fire clearance for only 2 ambulatory residents. Therefore, the facility did not adhere to the fire clearance and facility sketch. LPA Lee also observed the facility to be free of odor, clean and in good repair. LPA Lee observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA Lee toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. The hot water temperature was measured at 100.1 degrees Fahrenheit in the resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Grab bars and non-slip mat were observed to be stable and in good repair at this time. Smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is located in the kitchen and was last serviced on 01/04/2024. The last fire drill was conducted on 12/15/2023. LPA Lee observed the facility has a public telephone in the kitchen and the facility has the required posters posted. Continued LIC 809-C Facility thermostat observed at 79 degrees Fahrenheit. LPA Lee observed toxins located in the kitchen and laundry room are both kept locked and inaccessible to residents. LPA Lee observed sharp knives kept locked and inaccessible to residents. LPA Lee checked medication storage and found medication to be locked away and inaccessible to residents. LPA Lee reviewed and compared 4 out of 8 medication administration record (MAR) and it was not complete. LPA Lee observed (R2) Lipitor 40mg 8:00 PM medication was not marked as being given to residents from 01/01/2024 to 01/08/2024. Furthermore, it was also learned that while auditing the Lipitor 40mg medication (R2) had two extra pills left over which did not match with the start date of the medication. The first aid kit was checked and contained all the required components. LPA Lee requested residents and staff files for review. LPA Lee reviewed 5 out of 8 resident files and 3 out of 4 staff files and they were complete. LPA Lee reviewed staff criminal record clearances and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. The following documents will be email to LPA Lee ( pang.lee@dss.ca.gov ) by 01/16/2024 by 5:00 PM by end of day: (1) LIC 308 Designation of Administrative Responsibility (2) LIC 500 Personnel Report (3) Copy of Administrator Certificate (4) LIC 610 Emergency Disaster Plan (5) Proof of Current Liability Insurance As a result of this annual visit, the facility is not in compliance with Title 22 Regulation, and the deficiencies can be found on the LIC 809 D page. An immediate civil penalty was assessed during today's visit. An exit interview was conducted, and a copy of these LIC 809 reports, LIC 809-D page, LIC 421IM, LIC 811 and Appeals rights were provided to the facility.