Routine inspection·March 15, 2024

On March 15, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual inspection. LPA met with Caregiver, Arsenia Villadarez and explained the purpose of the visit. LPA toured the facility inside and outside including all of resident rooms, common areas & kitchen. The indoor and outdoor passageways were free of obstruction. No accessible bodies of water of fire safety hazards observed. Extra linen was observed. LPA toured four resident rooms; two of which are shared rooms and two are observed to be private resident rooms. All resident rooms were observed with all required furniture. LPA observed two full bathrooms. Bathrooms were observed clean and odor-free; equipped with liquid soap, paper-towels, and non-skid mats. LPA observed staff room located next to the bathroom. Extra linen supply was observed. First aid kit was present and complete. Living room and dining room was observed to be free from tripping hazards. A comfortable temperature is maintained and lighting is sufficient for comfort. Hot water throughout the facility measured at 115 degrees F throughout the facility. Sharps, toxins and medication were locked and inaccessible to residents. Carbon monoxide monitors are working properly. All fire extinguishers have been checked and current as of November 2023. LPA observed 2 days for perishables and 7 days non-perishables. Emergency drills are logged and done every four months. LPA reviewed 3 resident records and 3 staff records. Resident records are updated, complete and signed, however during record review and tour, LPA observed that one resident (R1) has a foley catheter, however an exception was not approved by CCL. In addition, although LPA observed home health documents and doctor's discharge documents, LPA did not observe a service plan to show what home health is responsible for and what the facility staff will be responsible for. Staff records are complete, with training logs that have met the basic requirement. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC809-D. Failure to correct the deficiencies may result in additional civil penalties. Report is reviewed with Caregiver and a copy is provided with appeal rights.