Routine inspection·April 11, 2024

On 04/11/2024 at 08:45 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 a staff and was granted entry to the facility. At the time of the visit there were three (3) staffs present, and five (5) residents present. Licensee/Administrator Milagros Azaula was contacted and informed of the visit. Licensee/Administrator Milagros Azaula arrived during the visit. LPA Brown explained the purpose of the visit to Licensee/Administrator Milagros Azaula. The facility is a five (5) bedroom, two (2) bathroom home with a kitchen/dining area, living room, laundry area and a garage. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) residents of which six (6) can be non-ambulatory residents, one (1) may be bedridden. The facility has six (6) 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). LPA Brown observed no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 77 degrees Fahrenheit. LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, lamps and storage space and with sufficient lightning. Moreover, LPA Brown observed that bathrooms were clean, and appliances were operating appropriately. LPA Brown observed grab bars and non-skid mat in the resident bathrooms. However, LPA Brown observed Resident #5 (R5) with half bed rail and no written order from R5's physician indicating the need for half bed rail for mobility. Deficiency will be issued. ***Continuation in LIC809C *** LPA Brown observed no appropriate signage of "No Smoking-Oxygen in Use" in Resident #3 (R3) room. Deficiency will be issued. LPA Brown measured and observed the water temperatures in the bathroom to be at 106 degrees Fahrenheit. The facility is equipped with operating smoke detectors, carbon monoxide alarms and charged fire extinguisher. Posters such as personal rights, the CCLD complaint poster, Ombudsman poster and the disaster plan were posted in a common area. There was a designated storage space for resident/staff files. There is a cabinet with the resident’s medications locked. However, LPA Brown observed residents 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. Deficiency will be issued. Food Service : Seven (7) days non-perishable and two (2) days perishable food supply observed at the facility. Care & Supervision: The facility has an administrator present in the facility. LPA Brown observed no staff scheduled to work at night (NOC) shift due to the facility having dementia residents. Deficiency will be issued Record Review: LPA reviewed three (3) resident files for admission agreements, updated physician reports, pre-placement appraisal (LIC603) and needs and services plans (LIC625). The files were complete with updated physician’s reports, admissions agreements, needs and services plan and preplacement appraisals. LPA reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with negative tuberculosis (TB) result. LPA Brown observed files were complete. However, three (3) Medications/Medication Administration Records (MARs) were audited and LPA Brown observed that staffs at the facility are not updating residents MAR when dispensing residents medications. Deficiency will be issued. Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, Chapter 8 of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), LIC809D forms, LIC9102 and Appeal Rights were discussed and provided to Licensee/Administrator Milagros Azaula.