Routine inspection·December 18, 2024

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Licensee (LN) Elizabeth Solorio. During the visit, LPA observed 5 residents and 3 staff. LPA explained the purpose of the visit. LPA toured the facility inside out with LN which included the Living room, kitchen, dining room, 4 restrooms and 4 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. LPA toured the garage, which is being used as storage and a laundry area. There was no obstruction to block the walkways. While touring the 2 bedrooms that are directly next to each other, LPA observed the flooring next to the entrance to the bathroom. The flooring sinks when stepped on and has damage. (Photograph was taken.) LN stated she has been working on fixing it. LN stated the flooring has been damaged for about a month. While touring bedroom #1, LPA observed one of the windows did not have a screen. (Photograph was taken.) While touring the living room, LPA observed the sliding screen door was missing. (Photograph was taken). While touring the backyard of the facility, LPA observed the fence, had a wooden slab that was missing, which left an area of the neighbors backyard exposed. LPA also observed a Canopy tent directly outside of the LN's room, which was damaged and had holes. (Photographs were taken.) Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 74 degrees F, and hot water temperature was measured at 107 degrees F in resident bathrooms. Page 1 Out of 2. Fire extinguisher was serviced in December 12, 2024. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by LN, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on October 1, 2024. LPA reviewed facility records for 3 residents. Resident R1 Physician's Report, dated 4/20/2017, states resident has a neurocognitive disorder. R1's newest Appraisal/Needs and Services Plan, is dated December 10, 2023. LN stated she did not have an updated physicians report or Appraisal/Needs and Services plan. R2's physician's report is dated October 25, 2012. LPA advised LN to have R2's physicians report updated, and to ensure its updated frequently enough to have up to date information. LN stated she would send a copy of R2's updated physicians report to LPA. LPA requested to reviewed R2's Appraisal/Needs and Services Plan. LN stated she could not find it. LPA reviewed 3 staff records. LN stated Staff S2's first aid documentation was not in the home, but it was completed and is current. LN stated Staff S3 has already signed up for his/her first aid training on December 21, 2024. LN stated she would send LPA documentation the first aid training has taken place. LPA requested to review staff training documentation for the year 2024. LN stated she has not conducted any training for her staff. LPA reviewed 3 resident medications and centrally stored medication records. LPA requested copies of the following documents be sent to LPA: 1.LIC 500, Personnel Summary 2.LIC 308, Designation of Administrative Responsibility 3.LIC400, Affidavit Regarding Client/Resident Cash Resources 4. Liability Insurance 5. Qualifications of Administrator (Certificate) 6. Please review your facility program for updates (incorporating new laws and/or regulations) LPA provided Dementia Care and RCFE regulation updates flyer. Deficiencies are being cited during today's visit. This report was reviewed with Licensee Elizabeth Solorio and a copy of the signed report was provided. Appeal rights were provided. Page 2 Out of 2. END OF REPORT