Routine inspection (multi-day)·January 29, 2024

Licensing Program Analysts (LPAs) Dang Nguyen and Juliana Barfield conducted an unannounced visit to continue a Required Annual Inspection which began on 01/22/2024. The facility file was reviewed prior to the visit. LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit with Director of Resident Care Raquel Mathews and Executive Director Kevin Booth. According to the facility’s license, the facility has a maximum capacity of 140 residents, of which 82 may be non-ambulatory and 16 may be bedridden. During today’s inspection, there were a total of 62 residents in care, of which 59 were non-ambulatory, 3 were ambulatory, and zero were bedridden. The facility's fire clearance did not include endorsements for delayed-egress doors or secured perimeter, and neither were present during today's visit. The submitted facility sketch was consistent with the current layout of the facility. During the annual inspection, LPAs, accompanied by licensee’s staff, toured the interior and exterior of the facility and inspected common areas and a sampling of resident bedrooms. LPAs privately interviewed multiple staff and residents. LPAs also reviewed multiple staff and resident records/files. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained required furniture. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment (PPE). The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Confidential records and centrally stored medications were kept in locked areas. [CONTINUED ON LIC 809-C, 1 of 2] [CONTINUED FROM LIC 809] The facility had at least two days of perishable food and seven days of non-perishable food present. The facility had cooking and dining utensils to facilitate resident meal service. The Main Kitchen Walk-In Refrigerator’s temperature was compliant at 40 F, and the Main Kitchen Walk-In Freezer’s temperature was complaint at 0 F. The auxiliary Walk-In Refrigerator was compliant at 40 F. The facility’s ambient internal temperature was compliant at 76 F. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents for whom they would be a danger. No pools or bodies of water were observed on the premises. Per the licensee, no firearms or ammunition are kept at the facility. Smoke and fire alarms, carbon monoxide detectors, emergency lighting, signals system, and facility telephone were all working. Fire extinguishers were serviced within the last 12 months. A complete first aid kit was present and readily accessible. Licensee's staff also presented proof of current/active business liability insurance. Required licensing postings were observed in visible areas of the facility. Where tested, hot water temperature at taps (which were used by residents for personal care) were initially non-compliant: Bedroom #103 sink was 128 F, Bedroom #112 sink was 125 F, Bedroom #142 sink was 128 F, Bedroom #210 sink was 122 F, and Bedroom #241 sink was 129 F. During the course of the annual inspection, Licensee adjusted the facility’s boilers to bring the water temperatures down to the compliant range. During a review of a sample of employee files, LPAs observed, and manager interview confirmed: Licensee did not maintain written evidence of a completed physical / health screening for Staff #1 (S1) and Staff #2 (S2) from time of hire, as was required. [See LIC811 Confidential Names List of select person identifiers used in this report.] Licensee did not maintain proof of current First Aid training for Staff #3 (S3) and Staff #4 (S4), both of whom assist residents with personal Activities of Daily Living (ADLs), as was required. [CONTINUED ON LIC 809-C, 2 of 2] [CONTINUED FROM LIC 809-C, 1 of 2] Three (3) deficiencies were cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D pages). Plans of Correction was jointly developed with Licensee. LPAs also issued Technical Assistance (TA) regarding infection control and training records (see the LIC 9172-TA pages). An exit interview was conducted with Mathews and Booth, to whom a copy of this report, the LIC 809-D pages, the LIC9172-TA pages, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.