Routine inspection·July 24, 2024

On 07/24/2024 at 10:00 AM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Brown met with Licensee/Administrator Jacqueline Dillard and was granted entry to the facility. At the time of the visit, there were two (2) staff present, and one (1) resident present. The facility is a two (2) bedroom, one (1) bathroom home with a kitchen/dining area, living room/activity room and a garage. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of four (4) non-ambulatory residents. The facility’s approved for four (4) hospice waiver. The current census is one (1) resident. LPA Brown was accompanied by Licensee/Administrator Dillard to conduct a general overall inspection, which included, but was not limited to the following: Physical Plant : The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 78 degrees Fahrenheit (F). LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathroom was clean, and appliances were operating appropriately. LPA Brown observed sufficient furniture and lighting throughout the facility. LPA Brown measured and observed the water temperatures in the bathroom to be at 100.3 degrees F. Deficiency will be issued. During the visit, Licensee/Administrator Dillard regulated/adjusted the water temperature to 106 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Fire extinguishers were also observed at the facility. Posters such as personal rights, the CCLD complaint poster, labor laws, and the disaster plan were posted in a common area. ***Continuation in LIC809C *** Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine Cabinet with the resident medications locked. LPA Brown observed a complete first aid kit and first aid book at the facility. Food Service : More than seven (7) days’ supply of Non-perishable foods and more than two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. Care & Supervision : The facility has an Administrator present during the visit. However, LPA Brown observed no staff scheduled to work the night shift, awake and on duty as required for facility with dementia residents. Deficiency will be issued. Record Review : LPA Brown reviewed one (1) resident file for admission agreement, updated physician report, and pre-placement appraisal. LPA Brown observed resident file reviewed was complete. LPA Brown reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test. LPA Brown noted that staff files reviewed were complete. LPA Brown audited Resident #1 (R1) medications and LPA Brown observed that one (1) of R1 medication was not given per R1's physician direction as LPA Brown found discrepancy on one (1) of R1's medication quantity per facility record. Deficiency will be issued. Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), LIC809D forms, and Appeal Rights were discussed and provided to Licensee/Administrator Jacqueline Dillard.