Routine inspection·September 13, 2024

Licensing Program Analyst (LPA) Miller arrived at 8:45 am to conduct a 1 year annual visit to the facility above. LPA met with Administrator, Merla Ventura and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Infection Control: The facility has a current Infection Control Plan, The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. The facility has EPA approved disinfectant spray and cleaners. The facility has a 30-day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). Physical Plant & Environment Safety: The fire extinguisher was last charged and inspected on 4/18/24. The facility has 3 resident bedrooms and 2 bathrooms. LPA was authorized to enter and inspect facility. The facility has a smoke and carbon monoxide detector that was tested and was working properly during visit. The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. LPA observed a bottle of Clorox bleach was left near toilet and accessible to residents in care. Administrator immediately removed bleach. The facility has sufficient space inside and outside for activities and visiting. The facility has a secured backyard and front patio for client use with plenty of shade. The facility has telephone and internet service for resident use. Continued 809-C Operational Requirements: The facility has a current plan of operation on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 6/23/25. The facility is approved for a capacity of 6. The fire clearance is granted for 2 ambulatory, and 4 non-ambulatory. Hospice is approved for 1. Staffing: The facility currently employes 2 full time staff. Staff records were not available at the time of inspection. LPA observed a female cleaning kitchen, bathroom and preparing food for resident. Administrator identified worker as a family member helping for the day. It was determined that family member did not have a background clearance completed and was required to leave the premises. Administrator Certificate is expired. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. LPA reviewed 4 resident files for signed Admission Agreements, Safeguard for property and valuables, LIC 602A Physicians report, Appraisals Needs and Services Plan, Emergency and ID forms. Food Service: The facility has 2-day perishables and 7-day non-perishables and plenty extra, to meet the food service requirement. LPA observed that freezer stored in garage is defrosting, as there were signs of melted ice in frame of door. Administrator will have repairman look at freezer as soon as possible. Incidental Medical Services: The facility uses Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed resident medications and observed that Administrator made notations on pharmacy label. Administrator was advised not to alter labels. LPA observed that medications were not expired and were kept in their original containers. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility currently has residents receiving home health services. Pursuant to Title 22 of the CA Code of Regulations, deficiencies were cited (refer to LIC 809-D) and a civil penalty was assessed. An exit interview was conducted, a copy of the report, Civil Penalty, and appeal rights were issued. Exit interview conducted and copy of report printed for Administrator.