Routine inspection·November 14, 2024

On 11/14/24, Licensing Program Analyst (LPA) Arvin Villanueva arrived at this facility unannounced to conduct an annual inspection visit. LPA met with Executive Director, Damion Anderson (ED) and explained the purpose of the visit. ED holds Administrator Certification # 6055657740 and expired on 3/25/2024. Per ED, he has submitted the required documents for renewal and it currently on a pending status. The facility is licensed to serve 61 non-ambulatory residents, of which 10 may be bedridden. Hospice waiver approved for 10. LPA and ED inspected the physical plant inside and outside to ensure there were no health and safety concerns. LPA observed the lounge area, lobby, and common areas. In addition, the kitchen areas, dining area, and activity room were toured. Medication room was toured. Kitchen was toured for adequate food supplies and storage. A review of the facility perimeter fence, side gates, and exits was conducted. A review of the resident rooms and bathrooms were conducted. LPA observed the facility to be free of odor, clean and in good repair at this time. LPA observed required furniture and lighting throughout the facility. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. Refrigerators and freezers were observed to store adequate amount of food. Temperatures for refrigerators and freezers were observed to be within regulatory standard as per observation and review of temperature log. The hot water temperature was measured at 118 degrees Fahrenheit in 4 sample resident rooms. The room temperature inside the facility measured between 71 and 75 degrees Fahrenheit. LPA observed centrally stored medications, toxins, and sharp knives kept locked and inaccessible to residents. LPA observed the fire extinguisher(s) were up to date and were last serviced on 6/7/24. LPA observed smoke and carbon monoxide detector(s) in the facility were in good repair. First aid kit was checked and is complete. Report continued on 809-C Review of 8 sample resident files (R1 - R8) include review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. Issues were noted: R5 did not have updated Physician's Report for review during this visit. Last Physician's Report on file was on 7/21/20. Per interview with ED confirmed they do not have the document on file for review but informed they sent the form to R5's physician. Medication review of 2 sample residents (R1 and R2) include review of physician orders for over-the-counter medications. No issues were noted at this time. Review of 6 sample staff files (S1 - S3) 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/evacuation drill and last drill was on 10/2/24. Facility has a dementia care plan and infection control plan. The following documents were obtained during today's visit: LIC 308 Designation of Administrative Responsibility, Proof of Current Liability Insurance, Resident Roster, LIC 500 Personnel Report and Staff Schedule for October 2024 and November 2024. Per California Code of Regulations, Title 22, deficiencies were cited during today's inspection. An exit interview was conducted, and a copy of this report and appeal rights were left at the facility.