Routine inspection·February 28, 2024

On 02/28/2024 at 09:30 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. Licensee Sushma Lal was contacted and arrived at the facility during the visit. At the time of the visit there's (1) staff present, and five (5) residents present. The facility is a five (5) bedroom, two and a half (2 1/2) bathrooms with a kitchen/dining area, and living room and garage. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) of which two (2) can be ambulatory residents and four (4) can be non-ambulatory residents. The facility's approved for two (2) hospice waivers. 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 of 76 degrees Fahrenheit. 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 temperature in a resident shared bathroom to be at 143 degree Fahrenheit. Deficiency will be issued. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Three (3) fire extinguishers were also observed at the facility. Posters such as personal rights, the CCLD complaint poster, Ombudsman poster labor laws, and the disaster plan were posted in a common area. ***Continuation in LIC809C *** Cleaning supplies and sharps were kept inaccessible to residents in care. However, LPA Brown observed Staff #2 (S2) two (2) bottles of medication in the kitchen drawer, not locked and accessible to residents in care. Also, during the tour of the facility, LPA Brown observed plant fertilizer at the backyard, not locked and accessible to residents in care. Deficiency will be issued. Moreover, LPA Brown observed all residents medication for the day were pre-poured in a small container up to bedtime. Deficiency will be issued. There was a designated storage space for resident/staff files. There is a Medicine cabinet with the resident’s medications locked. LPA Brown observed the complete first aid kit and first aid book at the facility. Also, during the tour of the facility, LPA Brown observed side fence gate locked with a padlock. Deficiency will be issued. To add to that, LPA Brown observed screen door in disrepair. Deficiency will be issued. LPA Brown also observed Resident #1 (R1), Resident #3 (R3) and Resident #5 (R5) with half bed rails and no written order from their physician indicating the need for half bed rail for mobility. Deficiency will be issued. 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 observed that the facility does not have updated liability insurance. Deficiency will be issued. Also, LPA Brown observed the facility not having the required Infection Control Plan. Deficiency will be issued. Moreover, LPA Brown observed no current fire drill or earthquake drill conducted at the facility. Deficiency will be issued. LPA Brown reviewed three (3) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPA Brown observed three (3) residents file reviewed do not have the required Pre-placement Appraisals and Needs and Services Plan. Deficiencies will be issued. LPA Brown reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test result. LPA Brown observed that Staff #5 (S5) does have criminal background clearance but the facility did not transfer S5 criminal background clearance to the facility. Deficiency will be issued. Also, during this visit, a civil penalty of $500.00 will be issued for not transferring S5 criminal record clearance to the facility. ***Continuation in LIC809C *** Medications/Medication Administration Record (MAR) were audited, and LPA Brown observed no issue. Per LPA Brown's review, the facility were cited for the same violation on 11/17/2023 for CCR 87608(a)(5)(A) Postural Supports and CCR 87705(l)(2) Care of Persons with Dementia. During this visit, a civil penalty of $250.00 per regulation for repeating the same violation within 12 months will be issued. Based on the observations made during today’s visit, deficiencies were issued per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), LIC809D, LIC9102 and Appeal Rights were discussed and provided to Licensee Sushma Lal.