Routine inspection·April 23, 2024

Unannounced annual visit made out to this facility on 04/23/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility staff person, Nena De La Cruz, who was requested by this LPA for her to go ahead and contact the facility designated Administrator, Nora Remolona, to inform her that CCL was present at this time. The facility designated Administrator arrived shortly thereafter to this facility while this LPA was conducting this annual visit. A brief interview was conducted with the facility designated Administrator at this time. It was learned that there were (5) residents under the care of hospice at this time. This facility has an approved hospice waiver for (6) residents at any given time. It was learned that there were (3) other residents who were receiving services through home health as well. This facility also has, on file, a program to accept and retain residents diagnosed with dementia at this time. Current census was 15 residents. A tour of this facility was conducted. Administrator certificate was observed to be present and in compliance at this time for facility designated Administrator Nora Remolona. Kitchen area was toured. Cabinets and drawers were reviewed. Food preparation stations, dishwashing station, and other areas intended for meal preps were toured. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. This LPA did observe additional food storage units which were present and functional at this time. A tour of the dining area, living area, and all other areas intended for resident use was conducted. Medication cabinet, located in kitchen hallway closet, was reviewed. Policies and procedures involving dispensing, documenting, and overall administration of resident medications were discussed with the facility designated Administrator at this time. The medication cabinet was observed to be locked and made inaccessible to the residents at this time. A tour of the resident bedrooms and restrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees. Linen closet, located in the facility hallway cabinet, was observed to contain a sufficient supply of towels, blankets, and linens to meet the needs of the residents at this time. Fire extinguishers, located throughout this facility, were observed to have been annually inspected on 11/28/2023 by the local fire extinguisher company, Armor Fire Extinguisher Services, and in compliance at this time. First aid kit was observed to be present and contained all of the required components at this time. Exterior grounds of this facility were toured. A review of the facility perimeter fence, side gates, and exits was conducted. A review of (5) facility resident files was conducted and noted on the following LIC 858. A review of (5) facility personnel files was conducted and noted on the following LIC 859. The following forms and documents were requested to be updated and submitted into CCL: 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 Codes. Appeal Rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interview