Routine inspection·August 30, 2023

On 8/30/23 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to continue an annual inspection that was commenced on 7/28/23. LPA Jensen met with Licensee Brenda McCarthy and explained the purpose of today's visit. The Administrator holds a current certificate number 6017049740 good through 7/18/24. LPA Jensen toured the grounds and observed the grounds to be well maintained and all pathways were unobstructed. The window screens were observed to be in good repair. The facility is 3 bedroom and 2 1/2 bath. The main entrance to the facility has a sign in sheet and postings for Resident Council, personal rights, and "See Something, Say Something". The interior was adequately furnished and lit. The facility was observed to be sanitary and free of odor. The thermostat was set at 72 degrees Fahrenheit for the comfort of the residents. The facility maintains an adequate supply of linens. All bedrooms are adequately furnished. The bathrooms have grab bars and non-slip mats for the shower/bath. The water temperature in the common bathroom was measured at 113 degrees Fahrenheit and is in compliance. The smoke detector and carbon monoxide detector were observed to be in good working order. There are night lights in the hallway and battery operated lighting is available in every room in case of a power outage. The facility conducts regular fire drills. LPA Jensen observed a first aid kit that was complete. LPA Jensen toured the kitchen. The facility maintains a 2 day supply of perishable food and a 7 day supply of non-perishable food. Knives, medications and toxins are locked and inaccessible to residents in care. LPA Jensen reviewed the medication and observed the Centrally Stored Medication and Destruction Record (CSMDR) to be incomplete. The facility accepted a resident without documenting the medication the resident arrived with. The medication on hand for Resident 1 (R1) was inconsistent with the Medication Administration Record (MAR) and Physician orders. Continued on LIC 809C... Continued from LIC 809.... LPA Jensen interviewed the sole resident and sole staff member present at the time of the visit. LPA Jensen reviewed 1 resident file and found it to be complete. LPA Jensen reviewed 1 staff file and determined there was no training records for the staff member maintained on site at the time of the visit. LPA Jensen requested a current copy of the liability insurance and an LIC 500 to be sent by 9/1/23. The Inspection Tool was used during the course of this visit. Deficiencies are being cited from California Code of Regulations (CCR) and/or Health and Safety Code (HSC). Failure to correct deficiencies may result in the assessment of civil penalties. An exit interview was conducted and a copy of this report and appeal rights were provided.