Routine inspection·May 16, 2024

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with staff S1, Victoria Regala, Administrative Designee. During the visit, LPA observed 6 residents and 2 staff. LPA toured the facility inside out with S1 which included the Living room, kitchen, dining room, 3 restrooms and 6 residents bedrooms. The front yard and backyard were inspected. There was no obstruction to block the walkways. While touring the garage, LPA observed two rooms inside the garage. LPA asked S1 if LPA could enter. S1 stated the staff inside, S2, was "napping". Inside the first room in the garage, LPA observed a black couch with a pillow and blanket. LPA observed S2's medication bottles on the dresser counter as well. S1 stated S2 naps in there because he/she is the night shift staff. LPA also inspected the other room in the garage, which Staff S3 was using, had a bed with pillows and a blanket. (Photographs were taken.) LPA interviewed Staff S2 and S3. Both staff interviewed stated they sleep in the garage and work the night shift from 10pm-7am. 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 75 degrees F, and hot water temperature was measured at 116 degrees F in both resident bathrooms. PAGE 1 OUT OF 2 Fire extinguisher was serviced in April 30, 2024. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by S1, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on May 2024. LPA requested to review the drill conducted in 2023. S1 stated that information is in the Los Altos care home and the facility ADM would return by tomorrow. LPA reviewed facility records for 3 residents. While reviewing residents R1 and R2's file, LPA discovered both had empty pre-admission appraisal forms. LPA asked S1 if they had completed them. S1 stated they did not have the forms filled out for R1 and R2 pre-admission appraisal. LPA reviewed 3 resident medications and centrally stored medication records. LPA conducted interviews with 2 residents. LPA reviewed 3 staff files. LPA requested to review staff training records. S1 stated the training records were in the Los Altos facility. S1 stated the training had been completed, but the records were not available. By the end of the visit, S1 was unable to provide copies of staff training or documents stating disaster drills had been conducted in 2023. Deficiencies are being cited during today's visit. This report was reviewed with staff S1, Victoria Regala and a copy of the signed report was provided. Appeal rights were provided. PAGE 2 OUT OF 2 END OF REPORT.