Routine inspection·July 23, 2023

Licensing Program Analyst (LPA) Jacqueline Shaw Ross conducted an unannounced annual visit. LPA met with Dearme Doverte, House Manager and explained the purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with California Code of Regulations, Title 22, Division 6. An overall tour of the facility was conducted inside and out. The facility is licensed for ten elderly non-ambulatory residents, and has an approved hospice waiver for six. There is approved bedridden fire clearance for up to ten. There are currently three residents on hospice. At the time of the visit, there were seven residents and two staff members present. LPA conducted staff and resident interviews. Tour included: Physical Plant: The facility is one story with seven bedrooms and three bathrooms. The tour of the front entrance, interior and exterior surroundings were observed to be in good repair with no pathway obstruction and facility's water temperature measured at 112.8 degrees Fahrenheit. LPA inspected all of the residents bedrooms and observed them to be clean, and odor free. The inspection also revealed sufficient lighting and mattress pads in residents bedrooms. Furthermore, smoke and carbon monoxide detectors were also inspected and found to be in working order. All cleaning solutions were observed in a locked secure area. The facility does not house firearms and/or ammunition on grounds. Emergency drills are conducted on a quarterly basis. The next drill is scheduled for the first week in August. Food Services: 7 day non-perishable and 2 day of perishable food supply were observed, and all food was properly stored and available to residents. Continued on LIC809C... Continued from 809... Staff present have a criminal record clearance on file and are appropriately associated to the facility. LPA review of staff files indicated staff were receiving ongoing training in ADL’s and Dementia Care. LPA review of Resident records indicate that in each file there is a current medical assessment, needs appraisal and a signed, dated admission agreement. During the medication audit, LPA observed the following deficiencies: - Medication for all residents was prepared in advance and stored in medication cups up to one day prior to administering to residents. LPA explained to House Manager that medication cannot be transferred from it's original container to another container for storage. - The facility had PRN medication on hand, such as, Acetaminophen - the facility did not have said medication on MAR list. Based on observations made by LPA, the facility was cited and deficiencies noted on LIC809D. An exit interview was conducted with House Manager, Dearme Doverte and a copy of this report, LIC809D, LIC811 and appeal rights was provided.