Routine inspection·April 15, 2024

On 04/15/2024 at 01:15 PM, 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 a staff and was granted entry to the facility. Administrator Paul Krause was contacted and arrived during the visit. At the time of the visit there were two (2) staff present, and five (five) residents present. The facility is a five (5) bedroom, two (2) bathroom home with a kitchen/dining area, living room, garage. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) non-ambulatory residents, of which one (1) may be bedridden and approved for two (2) hospice waiver. The current census is five (5) residents. LPA Brown was accompanied by Staff #2 (S2) 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. 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 sufficient furniture and lighting throughout the facility. LPA Brown measured and observed the water temperatures in the bathroom to be at 130 degrees Fahrenheit. Deficiencies will be issued. Administrator regulated the hot water to 119 degrees Fahrenheit during the visit. 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, Ombudsman poster, 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. However, LPA Brown observed two (2) residents with half bedrail but per documents review, no written order from physician indicating the need for postural support - bedrail for mobility in the two (2) residents facility file. Deficiency will be issued. Also, LPA Brown observed one (1) resident with full bed rail but not on hospice and per documents review, no approved exception on file. Deficiency will be issued. LPA Brown observed no Emergency Disaster Plan at the facility. Deficiency will be issued. LPA Brown did not observed Fire Drill or Earthquake Drill conducted at the facility. Deficiency will be issued.There is a Medicine Cabinet for the residents with the resident’s medications locked. LPA Brown observed the 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 in the facility with appropriate and enough hours to appropriately manage the facility. The facility has sufficient number of staff to provide care and supervision to the residents in care. Record Review: LPA Brown reviewed four (4) resident files for admission agreements, updated physician reports, pre-placement appraisals. LPA Brown observed one (1) resident Admission Agreement was not signed by the Licensee. Deficiency will be issued. LPA Brown observed no Personnel Records available during the visit. Deficiency will be issued. In addition, Administrator Krause reported to LPA Brown that staff records were maintained at the other facility. Deficiency will be issued. Moreover, LPA Brown observed Staff #3 (S3) working at the facility without criminal background clearance and S3 reported to LPA Brown that S3 has been working at the faciity since 12/2023. Deficiency will be issued. Also, LPA Brown observed Staff #1 (S1) working at the facility with criminal background clearance but criminal background clearance was not transferred to the facility. Deficiency will be issued and Civil Penalties were assessed during the facility visit with the amount of $500.00 and will continue to be assessed of $100.00 per day per citation until corrected for failure to obtain criminal record clearance for S3 and for not transferring S1 criminal background clearance to the facility. ***Continuation in LIC809C *** LPA Brown interviewed Staff #2 (S2) and S2 reported no Dementia training was provided to staffs at the facility. Deficiency will be issued. Medications/electronic Medication Administration Record (MAR) were audited, and LPA Brown observed no issue. 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, LIC9102 forms, LIC421BG and Appeal Rights were discussed and provided to Administrator Paul Krause.