Routine inspection·May 21, 2024

On 05/21/2024 at 8:28 AM, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA Lee met with direct care giver, Asena Motubula who then called administrator Salote Lewis to informed that CCLD is present. Administrator arrived to the facility approximately 30 minutes later. LPA Lee explained the purpose of today’s visit. Administrator Certificate # 6062098740 expires on 08/08/2024. The current census is 5 with 1 facility staff. This facility is a single story building licensed to served six (6) non-ambulatory residents and approved for 2 hospice waivers. LPA Lee inspected the physical plant including but not limited to the common area, kitchen, dining area, residents’ bedrooms, residents’ bathrooms, laundry room, staff room, garage, and outside courtyards of the facility to ensure compliance with Title 22 regulations. It was observed the facility was 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 the facility had sufficient seven-day non-perishable food supplies. It was observed that two-day perishable food supplies were not sufficient for 5 residents in care. Hot water temperature was measured at 122.1 degrees Fahrenheit in resident bathroom sink, which is not within the required regulation of 105 to 120 degrees Fahrenheit. During today’s visit administrator adjusted the water temperature and it then was measured at 114.1 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 kitchen and was last serviced on 04/03/2024. The last fire drill was conducted on 02/02/2024. LPA Lee observed the facility has a has a public telephone in the kitchen and the facility has the required posters posted. The facility has an infection control plan and an emergency disaster plan. Facility thermostat observed at 70 degrees Fahrenheit. LPA Lee observed toxins located in the garage were kept locked and inaccessible to residents. Continued LIC 809-C 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 5 medication administration record (MAR) along with residents’ medications. Records reviewed indicated that 1 out of 4 MAR log was inaccurate. Resident 1 (R1)’s Capsaicin 0.075 cream medication was not documented on the MAR. Per physician's order (R1)'s Capsaicin cream is to be apply four times a day for pain. Direct caregiver and administrator stated that (R1)’s cream is applied on (R1); however, it is unclear if (R1)'s Capsaicin cream is being apply since it is not documented. The first aid kit was checked, and it was complete. LPA Lee requested resident and staff files for review. LPA Lee reviewed 5 out of 5 resident files and 3 out of 3 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 05/27/2024 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 exit interview was conducted, and a copy of these LIC 809 reports, LIC 809-D page, Technical Assistant and Appeals rights were provided to the facility.