Routine inspection·May 17, 2024

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's required 1-year annual inspection. LPA met with Administrator, Dominica Oliva. During visit, LPA toured the facility to include the living room, kitchen, resident bedrooms, staff bedrooms, bathroom, common areas, garage, and exterior. All fire exit routes were free and clear of obstruction. Facility temperature maintained between 71 - 73 degrees Fahrenheit. Fire extinguisher last serviced on 04/29/2024. Carbon monoxide detector present. Facility has at least 2 days worth of perishables and 7 days worth of non-perishable foods. Refrigerator temperature maintained at 35 degrees Fahrenheit. Freezer temperature maintained at -3 degrees Fahrenheit. Items inside the refrigerator observed covered and labeled. Sharp objects, chemicals, disinfectants, and medications observed locked. Resident bedrooms equipped with beds, linens, adequate lighting, night stands, chair, and dresser. 3 residents with half bed rails has a physician's order on file. 1 resident's hospice care plan addresses the order for full bed rails. Resident bedrooms has operable door alarms and pull cords. Bathrooms equipped with grab bars, hygiene products, paper supplies, and non-slid mats. Hot water temperature maintained at 112 degrees Fahrenheit. LPA reviewed 4 resident files were complete to include an admission agreement, medical assessment, TB result, emergency contact information, consent forms, appraisal/needs and services plan, safeguard of personal property and valuables, and personal rights. LPA reviewed 4 residents centrally stored medications. SEE LIC809-C. LPA observed resident (R1) was not given 1 prescribed routine cream daily, as instructed by the physician because R1's prescription was written on the facility's medication record as a PRN. LPA observed resident (R2) was not dispensed 1.5 days of routine medication. Based on the facility's records, R2 had started the medication on 05/09/2024 but was only dispensed 7.5 out of 9 days of medication. R2's medication administration record did not show any missed medication. Facility was unable to provide reasoning. Photographs taken of R1 and R2's medication. LPA reviewed 3 staff files were complete to include a fingerprint clearance, 1st aid certification, health screening TB result, employee rights, and training. Facility has an emergency disaster plan. Facility has emergency lighting. Facility is conducting emergency drills quarterly, last drill was conducted in May 6, 2024. Administrator was advised. 1 resident on hospice requires an oxygen concentrator. Resident has a back-up oxygen tank. Oxygen in use signs posted on the front door. Posters observed to include but not limited to if you see something say something, facility license, emergency disaster plan. Documents requested to include the LIC500 and liability insurance by 05/18/2024. Deficiencies were cited per California Code of Regulations, Title 22. See LIC809-D. This report was reviewed with Administrator, Dominica Oliva and a copy of the report and appeal rights were provided.