Routine inspection·April 21, 2023

Unannounced annual visit made out to this facility on 04/21/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility caregiver, Nena De la Cruz, who was requested by this LPA to go ahead and contact the facility designated Administrator, Nora Remolona, to inform her that CCL was present at this time to conduct an annual visit. Contact was made with the facility designated Administrator, Nora Remolona, over the facility telephone and she stated that she was an hour and a half away from this facility. This LPA stated that he will conduct the visit and await her arrival. The facility designated Administrator arrived later to this facility while this LPA was conducting this annual visit. It was learned that there were (3) residents under the care of hospice at this time. This facility does have a hospice waiver to accept and retain up to (6) residents at any given time. It was learned that there were (3) residents under the care of home health with (7) residents diagnosed with dementia at this time. Current census was 15 residents. Tour of this facility was conducted. Dining area, living area, and all other areas intended for use by the facility residents were toured. Furniture and furnishings were reviewed to make sure that they were in good repair and able to meet the needs of the residents at this time. Kitchen area was toured. Food storage unit, refrigerator/freezer, was observed to be present. A review of the facility's 2-day perishable and 7-day nonperishable food supply was conducted. Additional food storage units, located in the interior kitchen walkway, was observed to be in use and reviewed by this LPA at this time. Medication cabinet, located in the facility kitchen cabinet, was reviewed. Policies and procedures related to storing, handling, and documentation of the facility resident medications were discussed with the facility caregiver at this time. First aid kit, located in medication cabinet, was observed to contain all of the required components at this time. A tour of the facility resident bedrooms was conducted. A review was performed to make sure that the bedroom furniture and furnishings were in good repair and able to meet the needs of the residents at this time. A tour of the facility resident restrooms was conducted. A review was performed to make sure that the restrooms were in good repair and able to meet the needs of the residents at this time. Hot water temperatures were taken, in two of the resident restrooms, and measured to make sure that they were within the allowed range of 105-120 degrees at all times. Grab bars and non skid mats/surfaces were observed to be present and in compliance at this time. Linen closets (2) located in the facility hallway were reviewed. Fire extinguishers, located throughout this facility, were observed to have been annually inspected on 11/219/2022 by the local fire extinguisher company, Armor Fire Extinguisher Company, and in compliance at this time. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all exits was conducted. A review of (5) facility resident files was conducted. A review of (5) facility staff files was conducted. The following forms and documents were requested to be updated and submitted into CCL for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Code. Appeal rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interview