Routine inspection·February 7, 2024

Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced Annual Inspection to the above-named facility. LPA was greeted by Staff 1 (S1) and explained the purpose of the visit. Ruth Grande, Administrator participated in the inspection at approximately 12:55 pm. Entrance interview conducted. The facility is a three-story Residential Care Facility for the Elderly (RCFE) with a hospice waiver for 20. Currently, there are 20 residents with a dementia diagnosis, 18 residents on hospice, 10 residents on oxygen, and 3 bedridden residents. A tour of the physical environment and accommodations were assessed, and the following was noted: LPA observed the required posting of the complaint poster, bill of rights and Resident’s Rights. LPA inspected the facility for fire safety and other hazards. The facility entrance consists of a large lobby, a concierge desk for check-in, and a hallway at the right of the lobby leading to the administration offices. Immediately past the concierge’s desk is a stairway that leads to the residential area. Residents participate independently in live entertainment and music, worship support, exercise activities, card games, lectures, Resident Council Townhall meetings, Bingo, art, reading club, pet therapy, arts and crafts, and outings to parks, restaurants, shopping excursions, museums, theatre events, and other local attractions. The fire extinguishers were charged and last serviced on 12/28/2023. LPA observed elevators are in good working order. Please continue to 809-C, Page 2. During today’s visit, the medication inventory and Medication Administration Record (MAR) for Resident 1 (R1) revealed an overcount of Metropolol XL 100mg. R1’s prescribed medication of Metropolol XL 100mg medication began on 10/31/2023 with a bottle count of 150 tablets. R1’s prescribed medication is 1x per day in the AM administered from 10/31/2023 through 2/7/2024. At approximately 2:46 pm, Staff 1 (S1) conducted a medication count and determined there were 125 tablets remaining in the bottle. At approximately 2:55 pm, Staff 2 (S2) confirmed a medication count of 125 tablets remaining in the bottle. At approximately 3:12 pm, Staff 3 (S3) also confirmed a medication count of 125 tablets remaining in the bottle. S3 stated there is no record of R1 refusing medications from 10/31/2023 through 2/7/2024 and the MAR reflects the am medication was given in the am from 10/31/2023 to 2/7/2024. Due to time restraints, LPA will return at a later date to continue the annual inspection. The following deficiencies were observed (see LIC 809-D) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.