Routine inspection·July 26, 2024

Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced annual required visit. LPA was granted entry and met with caregiver Edmund De La Calzada, who was informed of the purpose of the visit. At the time of the visit there was two (2) staff and six (6) residents present. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted interviews. LPA observed the following: LPA observed a three (3) inch oval shaped hole in the floor near the dining room area. A deficiency will be issued under Title 22 Regulation 87303(a) . Washer and dryer is located outside in the backyard. LPA observed laundry detergent and bleach out and inaccessible to residents in care. Kitchen cabinet under the sink was unlocked and had bug spray and cleaning solutions accessible to residents in care. A deficiency will be issued under Title 22 regulation 87309(a) . Sharp objects in a kitchen drawer was unlocked and accessible to residents diagnosed with dementia in care. A deficiency will be issued under Title 22 regulation 87705(f)(1) . The smoke detector and carbon monoxide was operational, and the hot water temperature met department requirements. Facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. LPA reviewed three (3) staff files and training. All staff have the required personnel records on file and criminal record clearance and updated training along with CPR/First Aid. LPA was informed Staff Two (S2) was not fingerprint cleared and had assisted Staff One (S1) for the day due to a staff call off. A deficiency and civil penalty will be issued under Title 22 Regulation 87355(e) . S2 was informed they had to leave the facility and could not continue to provide care and supervision to the residents in care. Six (6) resident files were reviewed. Resident One (R1), Resident Two (R2), and Resident Three (R3) did not have a resident pre-appraisal in their file for review during the visit. A deficiency will be issued under Title 22 Regulation 87457(c) . Resident Two (R2), Resident Three (R3), Resident Four (R4), and Resident Five (R5) who are diagnosed with Dementia did not have an updated LIC 602 Physician's Orders during LPA's visit. A deficiency will be issued under Title 22 Regulation 87705(c)(5). Resident medication was centrally stored and locked in a cabinet located in the dining room. LPA observed PRN medication for Resident One (R1) and R2 administered to residents by staff without documenting the date and/or time PRN was given to the resident. A deficiency will be issued under Title 22 regulation 87465(d)(3) . LPA observed medication prescribed to Resident Six (R6) in a ziplock back with "back-up meds" written in sharpie. R6's medication had a "use before" date of 10/01/2022. A deficiency will be issued under Title 22 Regulation 87465(i) . LPA reviewed the facility's emergency and disaster plan. Facility does not have an updated resident roster for staff readily available in preparations for an emergency. A deficiency will be issued under Health and Safety Code 1569.695(e)(1) . Facility has not conducted and documented a quarterly disaster drill with staff from each shift. A deficiency will be issued under Health and Safety Code 1569.695(c) . An exit interview was conducted where a copy of this report, deficiency page(s) LIC 809-D, Confidential Names LIC 811, Civil Penalty, and Appeal rights were provide to caregiver Calzada.