Routine inspection·November 21, 2023

On 11/21/2023 at 08:32 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 Administrator Russell Bernardo, was granted entry to the facility. At the time of the visit there were two (2) staff present, and six (6) residents present. Licensee/Administrator Evafe Green – Sosnovsky was contacted and arrived during the visit. The facility is a five (5) bedroom, three (3) bathroom home with a kitchen/dining area, living room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) non-ambulatory residents and one (1) may be bedridden and with approved hospice waiver for six (6). The current census is six (6) residents. LPA Brown was accompanied by Administrator Bernardo 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 (CCL). LPA Brown observed obstructions to outdoor passageways as the backyard was observed with unused grills, ladder, tables, chairs. Deficiency will be issued. In addition, LPA Brown observed cleaning supplies not locked in the laundry room and are accessible to residents in care. Deficiency will be issued as this pose immediate health, safety and personal rights risks to residents in care. The facility is maintained at a comfortable temperature. LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA Brown observed no non-skid mat or strips in the hallway bathroom. Deficiency will be issued. Also, the cleaning supplies storage cabinet lock was broken or in disrepair located in the laundry room making it accessible to residents in care. Furthermore, LPA Brown observed pre-poured residents medication for the whole day, not locked in the kitchen drawer. Deficiency will be issued. ***Continuation in LIC809C *** Also, LPA Brown observed Resident #3 (R3) with full bed rails and Administrator Bernardo reported to LPA Brown that R3 is not on Hospice Care and no written order from the physician was observed indicating the need for postural support. LPA Brown observed no exception letter submitted and approved by Community Care Licensing Division (CCLD) for R3's full bed rails. To add to that, LPA Brown observed Resident #1 (R1), Resident #2 (R2), Resident #5 (R5) and Resident #6 (R6) have full bed rails. Administrator Bernardo reported to LPA Brown that R1, R2, R5 and R6 were under Hospice Care but per documents review, LPA Brown observed R1, R2, R5 and R6 do not have Hospice Care Plan that specifies the need for full bed rail. Deficiencies will be issued. Moreover, during the tour of the facility, LPA Brown observed the side gate secured and locked with padlock. This poses immediate safety risk to residents in care. Deficiencies will be issued for locking/securing the side gate with padlock. LPA Brown observed sufficient furniture and lighting throughout the facility. LPA Brown measured and observed the water temperatures in the bathroom to be at 115 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster and the disaster plan were posted in a common area. Moreover, during the tour of the facility, LPA Brown observed two (2) scissors in an unlocked kitchen drawer, accessible to residents in care. Deficiency will be issued as this pose immediate safety risks to residents in care. There was a designated storage space for resident/staff files. There is a cabinet with the majority of the resident’s medications locked in the medication room. LPA Brown found medications pre-poured in a small container for the day, up to bedtime medication for each resident at the facility. LPA Brown explained that no medications shall be transferred between containers. The facility will be issued deficiencies for pre-pouring residents medications for the day as this pose immediate health, safety and personal rights risks to residents in care. To add to that LPA Brown observed Nutritional Supplements or Vitamins not locked and accessible to residents in care. LPA Brown informed Administrator Bernardo that deficiency will be issued as this pose immediate health and safety risks to residents in care. Food Service: Seven (7) days non-perishable and three (3) days perishable food supply observed at the facility. Care & Supervision: The facility has an administrator present in the facility. LPA Brown observed sufficient number of staff to provide care and supervision to the residents in care. ***Continuation in LIC809C *** Record Review: LPA reviewed six (6) resident files for admission agreements, updated physician reports, and needs and services plans. The files were complete with updated physician’s reports, admissions agreements, and preadmissions appraisals. LPA reviewed five (5) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA found that five (5) of the five (5) staff have CPR training, staff are properly trained in medication, dementia care, and basic training required for an RCFE. However, LPA Brown observed two (2) of the five (5) staff do not have Health Screenings in their facility file. Medications/MARs records were audited and appeared to be dispensed appropriately by staff members. Based on the observations made during today’s visit, twelve (12) 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 Evafe Green – Sosnovsky and Administrator Russel Bernardo.