Routine inspection·May 3, 2023

On 5-3-23 at 9:46am, Licensing Program Analyst (LPA) Michael Bilger arrived at this facility unannounced to conduct an annual inspection visit. LPA met with the administrator Orchid Damrichob and explained the purpose of the visit. LPA Bilger inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside of the facility to ensure compliance with Title 22 regulations. Facility is a 6 bed residential care facility for the elderly with a current census of 5. Facility has 4 bedrooms and 2 bathrooms for resident use. Facility has a formal dining room and a formal living room. LPA also conducted the inspection using the CARE tool. Facility currently provides care for 0 bedridden, 2 hospice, 5 non-ambulatory (total residents), and 0 ambulatory residents. The facility has an approved COVID Mitigation plan LIC 808 form in place. The facility conducts routine symptom screening for employees, residents, and visitors as necessary. LPA observed the facility to have hand washing, COVID - 19 informational, and social distancing signs posted throughout the facility. The facility has a designated infection control lead. Common touch surfaces are cleaned after each use. Water temperature reads 105*F to 120*F in the bathroom and room temperature reads 78*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked 2-17-23. Facility has an emergency food and water kit. LPA observed toxins unsecured in an outside shed during tour. LPA also observed a broken window screen on the left side of facility property. Medication storage area was observed to be locked and inaccessible to residents in care. Medications were reviewed and contained accompanying regulatory required Physician’s orders. First aid kit was observed to have adequate supplies and accessible to staff. {Cont. on 9099C} During this inspection 5 resident files and 4 staffing files were reviewed for regulatory compliance. Staffing files did not contain evidence of completed regulatory training requirements for staff including general staff training and medication training requirements. All staff noted on LIC 500 contained criminal background clearances. LPA completed 2 resident interviews and 2 staff interviews. Resident files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required. Facility’s liability insurance is current and update to date per regulatory requirements. Facility does not contain any bodies of water. LPA observed personal rights, resident council and complaint information posted. Facility has appropriate internet access available for resident use. LPA observed facility’s activity calendar and sufficient equipment and supplies to meet activity program needs of residents in care. LPA reviewed facility’s disaster plan to ensure regulatory compliance. Facility conducts quarterly fire drills. Facility has 1 resident with bedrails with physician orders in place . LPA requested an updated copy of LIC 308 and LIC 500. Per California Code of Regulations, Title 22 and health and safety codes, deficiencies were observed during this visit. Exit interview was held and a report was given to Administrator Orchid Damrichob. Appeal rights provided.