Routine inspection·July 10, 2024

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Licensee Lilia Rena. According to the facility’s license, the facility has a maximum capacity for six (6) residents, of whom all may be ambulatory or non-ambulatory, but none may be bedridden. Per LPA observation and review of each resident’s latest LIC602 Physician’s Report: During today’s visit, there were a total of three (3) clients in care, and none were bedridden. This facility’s license does not include endorsements for secured perimeter or delayed egress doors, and none of these were present during the visit. During today’s visit, LPA interviewed multiple staff and residents. LPA reviewed all staff and resident records/files. LPA, accompanied by Licensee’s staff, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in general good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens, hygiene supplies, and Personal Protective Equipment were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility’s ambient internal temperature was complaint at 73 F. Hot water temperature at taps accessible to residents were all compliant: Kitchen Sink was 111.1 F, Bathroom #1 Sink was 111.6 F, and Bathroom #2 Sink was 112.1 F. Appliances to preserve perishable food were also compliant in temperature: Kitchen Refrigerator was 31 F and Kitchen Freezer was 0 F. Garage Refrigerator was 39 F and Garage Freezers were 0 F and 0 F, respectively. There was at least two (2) days of perishable food, and at least seven (7) days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. [CONTINUED ON LIC 809-C, 1 of 2] [CONTINUED FROM LIC 809] There were no sharp objects, toxic chemicals/poisons, active fireplaces, or open-faced heaters accessible to residents. Medications were labeled, as required, and stored in locked areas. Confidential records were stored in locked areas. No pools or bodies of water were observed on the premises. Per the Licensee, no firearms or ammunition are kept at the facility. Carbon monoxide detector, smoke detectors, emergency lighting, and facility telephone were all working. The facility’s fire extinguisher was serviced within the last twelve (12) months. A complete first aid kit was present and readily accessible. Required licensing postings were observed in visible areas of the facility. Confidential records were stored in locked areas. Licensee's staff also presented proof of current/active business liability insurance. During records review, LPA observed, and staff interviews confirmed: Resident #1 (R1) had an as-needed (PRN) medication made available to them by their doctor. [See LIC811 Confidential Names List for a description of resident identifiers used in this report.] Staff had given R1 this PRN medication often, prior to LPA’s 07-10-2024 visit. However, the staff assisting R1 did not record in writing the date, time, dosage, and the resident’s response to doses of this PRN which were given to them, as was required. For R1, Resident #2 (R2), and Resident #3 (R3), Licensee had not prepared a written record of care (i.e., a “care plan”) describing the services the resident will receive in the facility and the resident’s preferences, which was required to be done within two (2) weeks of admission to the facility. Because these care plans did not exist for R1, R2, and R3, those residents’ respective responsible persons (RPs) also did not have the opportunity to meet with Licensee to review them (which was required to be done at least annually). The latest LIC603 Resident Appraisals which Licensee had conducted on R1, R2, and R3 were all more than one year old. (Regulation required these residents’ condition to be reappraised upon any change in condition, but also at least annually.) For R3, Licensee did not have a record of body weight measurement for them. For R1, it had been over seventeen (17) months since Licensee last obtained a body weight measurement for them. For R3, it had been over sixteen (16) months since Licensee last obtained a body weight measurement for them. (Regulation required Licensee to “regularly observe” residents for changes in physical condition, to include “unusual weight gains or losses.”) [CONTINUED ON LIC 809-C, 2 of 2] [CONTINUED FROM LIC 809-C, 1 of 2] LPA also observed, and Licensee interview confirmed: Licensee did not perform emergency/disaster drills with the staff and/or residents. (Regulation required each shift to be drilled at least once per quarter). Licensee did have proof that 4 of 4 staff were trained on its written LIC610 Emergency Disaster Plan and the staff’s individual roles/responsibilities under this plan. (Regulation required staff to be trained on the plan at time of hire and at least once per year thereafter). Licensee did not have proof that 4 of 4 staff received training on the use of Personal Protective Equipment (PPE). (Regulation required staff to be trained on PPE annually.) Licensee also did not have proof that 4 of 4 staff received training on Resident’s Personal Rights described in law. (Regulation required staff to be trained on this topic initially and on an ongoing basis). Five (5) deficiencies were cited per California Code of Regulations, Title 22, and three (3) deficiencies were cited per California Health and Safety Code (refer to the attached LIC 809-D pages). Plans of Correction were jointly developed with the Licensee. LPA issued two (2) Technical Violations (TVs) regarding physician-authorized medication lists and night lights in bathrooms and hallways (refer to the attached LIC9102-TV pages). LPA also provided Technical Assistance (TA) regarding obtaining updated medical assessments for residents, and regarding staff auditory alert devices on exit doors (refer to the attached LIC 9102-TA page). An exit interview was conducted with Rena, to whom a copy of this report, the LIC 809-D pages, the LIC9102-TV pages, LIC9102-TA pages, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.