Routine inspection·August 8, 2024

On 08/08/24 at 11:02am Licensing Program Analyst (LPA) Javina George made an unannounced visit for the purpose of conducting a 1 year required visit/annual inspection. LPA George met with Administrator William Lee and informed of the purpose of today's visit. The facility is licensed to serve residents age range 60 and over, of which 1 may be non ambulatory and 5 ambulatory residents. The facility has an approved hospice waiver for (1). There are currently (2) residents receiving hospice services. The Administrator will submit a hospice waiver increase. Below is a summary of what was observed during today’s inspection: Infection Control: LPA George observed that the facility has an updated Infection Control Plan on file and is demonstrating best practices in the facility to maintain a healthy environment for staff, residents and visitors. Physical Plant: LPA toured the interior and exterior of the facility and observed that there a sufficient bedrooms (6) and bathrooms (2.5) for resident use. The facility was observed to have the required furniture and linen to be present and in good condition in resident bedrooms. The exits are free from obstruction and that there is plenty of space for activities. In the backyard there is a covered patio, and a gazebo. There are no pools or bodies of water on the premises. LPA observed for the facility sketch to not match the physical lay out of the facility as the licensee added staff break rooms, that have beds inside. LPA observed for one room to have a green suitcase, however all staff and the Administrator William denied that there are live in caregivers. Staff Records: LPA observed that there are sufficient staff present to meet the needs of residents. LPA George confirmed that there is an Administrator present. LPA observed for the additional Administrator William Lee to not be associated to the facility, but has proper fingerprint clearance. Guardian information will be provided. However per the records review and confirmation from the Administrator William all staff present at the time of LPAs visit are volunteers. All volunteers are paid were observed to have criminal record clearance and were associated to the facility. The volunteers were included in the staffing plan and were left unattended without any supervision. Deficiency cited. Resident Records: LPA conducted a review of (2) resident files to confirm that they have the required information present in their files, including Physician's Report, Admissions Agreement, and current Needs & Services Plan. (1) resident was observed to not have a current medical assessment completed, as the last assessment was in May 2023. In addition LPA conducted a review of the resident roster as LPA observed for there to be more than one non ambulatory resident as 1 resident was observed using a walker, 1 was observed using a motorized wheelchair and the third resident was in a wheelchair. The facility fire clearance was granted for 1 non ambulatory and 5 ambulatory residents. Deficiency cited. Food Services: The kitchen and dining area to be maintained in a clean and healthful manner. Sufficient dishware and silverware were present for resident’s use. LPA George observed the facility to have the required amount of 7 day supply non-perishable and a two supply perishable food items. LPA observed for there to be 3 expired canned food items, which were discarded at the time of LPAs visit. Medication: Resident medication was observed to be locked in the cabinet inside the kitchen and inaccessible to residents. A review of medication revealed that there was (5) missing initials on the Medication Authorization Record MAR, however LPA was able to verify that the medication had been dispensed. The Administrator stated that a training will be given which will include reminders to sign off on the medication after it has been administered . Emergency Disaster Preparedness: The facility has an Emergency Disaster Plan on file and conducts regular disaster drills on a quarterly basis. The last drill was conducted on 07/31/24. The smoke and carbon monoxide detectors were tested and were found to be operable. The facility has a fully charged fire extinguishers. There are no known guns or ammunition on the premises. The hot water was tested and was found to be within regulatory limit measuring at 110-113.8 degrees Fahrenheit. The facility has emergency food and water supply. The sharps and hazardous chemicals were observed to be locked and inaccessible to residents in care. Based on today's inspection a citation will be issued in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8). An exit interview was conducted and a copy of this report, 809D, appeal rights, and Proof of Corrections form LIC 9098, were provided to William Lee, Administrator.