Routine inspection·January 15, 2025

Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced required Annual Inspection to the above-named facility. The facility is licensed as a Residential Care Facility for the Elderly (RCFE). Upon arrival, LPA met with Executive Director Robert Glock and Wellness Director, Tina Tran, RN. LPA announced the purpose of the visit. The facility is licensed for 126 non-ambulatory residents and a hospice waiver for 10 residents. Currently, there are 96 residents residing in the facility and two residents are currently on hospice. Entrance Interview Conducted: The facility is four stories with no bodies of water. Entrance into the facility is the Ground floor which leads into a large common area, reception area, administrative offices, and a large dining area. There is an outdoor patio off the dining area conducive for social distancing. Also on the ground floor are an activity room, activity offices, hair salon, laundry rooms, a library, and the kitchen. The kitchen is a large industrial size kitchen consisting of grills, ovens, heating lamps, fryers, industrial size refrigerators and freezers, large pantries for food storage, and a dishwashing station. Floor #1 consists of Nurses’ station, Nurse’s office, testing room, approximately 74 residents’ rooms, Physical Therapy/Gym room, an outdoor patio, and a staff break room. Residents’ records are kept in the Nurses’ station on Floor #1. Floor #2 is residents’ rooms only. Floor #3 consists of a rooftop deck with open-air and outdoot covered seating, potted plants, and panoramic views. Residents may participate at will in various activities based on their individual interests and preferences. Activities include mental wellness sessions, historical biographical mapping, book club, garden club, residents' social gatherings, religious study groups, singing groups, chair yoga, eye-hand coordination activity, Bingo, aroma therapy, celebrations of special events and holidays, scenic excursions to local interest sites and excursions to local retail businesses and eateries. Please continue to 809-C, Pg 2. During today’s visit, the medication inventory and Medication Administration Record (MAR) for Resident 1 (R1) revealed the following: R1 is prescribed two tablets of Senna 8.6mg by mouth each evening. Medication inventory revealed R1 was administered one tablet each day, not two as prescribed. Prescription states “Hold for loose stools or diarrhea”. MAR reflects R1 refused medication on 1/1/2025. R1 is prescribed 400mg of Acyclovir, 1 tablet by mouth twice daily. Based on the recorded “opened” date, the medication inventory revealed one extra tablet was administered to R1. 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.