Routine inspection·May 21, 2024

On 05/21/2024 at 12:48 PM, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA Lee met with direct care giver, Helen Agbiriogu and Irene Iberi who then called administrator Joyce Diala to informed that CCLD is present. Administrator stated that she won’t be able to join the visit. LPA Lee explained the purpose of today’s visit. Administrator Certificate # 6035237740 expires on 08/05/2025. The current census is 6 with 2 facility staff. This facility is a single story building licensed to served six (6) residents. Room 1 and 3 are cleared for non-ambulatory residents and room 2 are cleared for ambulatory residents. 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 and clean. LPA Lee observed in resident bedroom # 3 the sliding screen door was not in good repair. LPA Lee observed care staff Helen tried to put the screen back on the rail and was not able to put the sliding screen back on. 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 6 residents in care. Hot water temperature was measured at 1110.2 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Grab bars and non-slip mat were observed to be stable and in good repair at this time. Continued LIC 809-C Smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is located in the hallway and was last serviced on 07/17/2024. LPA Lee observed the facility has a has a public telephone in the common area and the facility has the required posters posted. Facility thermostat observed at 73 degrees Fahrenheit. LPA Lee observed toxins located in the hallway closet and 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 3 out 6 medication administration record (MAR) along with residents’ medications. Records reviewed indicated that resident 1 (R1) Quetiapine 25 MG medication not stored in its originally received container. The instruction for the medication is to take one-half tablet by mouth. It was learned that care staff pre-cut the tablet and stored the half tablets in an extra container and created a label for the Quetiapine medication. LPA Lee asked to inspect the facility’s first aid kit and care staff were not able to provide LPA Lee the first aid kit other than bandages. LPA Lee requested resident and staff files for review. LPA Lee reviewed 5 out of 6 resident files and based on record review (R2) and (R3) diagnosed with dementia does not have a current LIC 602 Physician Report in their files. LPA Lee reviewed 2 staff files and they were complete. LPA Lee also requested to review administrator Joyce Diala’s file, and it was learned that facility staff was not able to be located administrator's file. A brief interview was conducted with administrator Diala, who stated that she is not sure why her file is not at the facility and will follow-up on her file. 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 05/31/2024 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, and Appeals rights were provided to the facility.