Routine inspection·November 27, 2023

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Administrator, Victor Burachek, and Natalia Burachek, caregiver and explained purpose of inspection. LPA observed (1) resident watching television in his wheelchair in the common area and (4) residents in their rooms. LPA observed a physical therapist staff arrive to care for one resident.The facility is licensed for (5) non-ambulatory and (1) ambulatory residents and has a hospice waiver for (1). Currently there are (5) residents and no residents are under hospice care. LPA and the Administrator toured the interior and exterior of the facility including the common areas, (6) resident bedrooms, (2) shower rooms, (4) resident bathrooms, kitchen, office, laundry area and garage. LPA observed the facility to be clean, in good repair and odor-free, and the bathrooms to have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters. LPA observed sufficient 2+day perishable supply of food, including fresh produce, and 7+day non-perishable supply of food. Sharps, toxins and medications were locked in the kitchen. LPA observed sufficient linens/blankets/incontinent supplies, PPE, and a complete First Aid kit. The inside temperature was 72*F. Hot water temperature measured 110*F in a resident bathroom. The fire extinguisher was last serviced 12/28/22 and will be serviced again by 12/28/23. Fire/smoke monoxide alarms are in working order. There is an unlocked exit in the backyard and plenty of outdoor/indoor space for activities. There are no pools. LPA reviewed (4) of (5) resident files- files were organized and contain current documents. Medications were reviewed for (3) residents and no discrepancies were noted. Documentation is maintained and meds are pre-poured only for the day. (2) of (2) staff files were reviewed. RCFE Administrator certificate is pending renewal per on-line check today. Documentation of training requested to be kept on file. CPR/First Aid is due in November 2023- to be completed and documentation provided. cont on 809C-1.. 809C-1... Infection Control Plan was reviewed- LIC9282 provided as courtesy. LPA provided updated copy of LIC613-2- Personal Rights to be provided to residents and posted. LPA obtained an updated copy of LIC308 and requested an updated copy of LIC500 and LIC610E (Emergency Disaster Plan) by 12/4/23. Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (1) deficiency is cited on the 809D page. Exit interview. Copy of report and appeal rights provided.