Routine inspection·July 16, 2024

On 7/16/2024 at 1:00 p.m. Licensing Program Analyst (LPA) Maria (Mita) Partoza arrived and conducted an unannounced required 1 year inspection visit and met with Administrator (ADM), Mila Valisto. ADM contacted licensee, Marie Pendar, due to previous commitment was not able to stay in the facility. Licensee/ADM was in constant contact via phone with ADM. Licensee Marie Pendar arrived at the facility at around 6:20 p.m. LPA observed a ramp leading to the front door free from obstruction. The facility is a Residential Care Facility for the Elderly (RCFE) licensed to serve ages 60 and over 6 non-ambulatory, and a waiver for 2 hospice care. The facility's has 5 residents (R1 to R5) that have mild to advanced neurocognitive impairment. 4 staff were present including the ADM at the time of the visit. 5 residents were present at the facility. LPA observed 5 of 5 residents are in the bedroom. 2 of 5 are non-ambulatory and 3 of 5 are ambulatory. The facility has 5 resident room (BR2 to BR6) and 1 staff room (BR1). At 1:05 p.m. LPA toured the facility inside and outside with ADM, including but not limited to the kitchen, bathroom, dining room, living room, residents rooms, staff room, backyard and walkways. LPA observed the Personal Rights disclosure, Long Term Care Ombudsman (LTCO) prominently posted on the wall, visible to visitors, resident and staff. The temperature inside the home was at 73 degrees F. LPA and ADM toured the 5 bedrooms and LPA observed the rooms to be organized and free from debris and has sufficient storage for resident's personal belongings. 5 of 5 resident bedrooms have exit doors and are free from obstruction. 1 of 5 bedroom is shared by 2 residents. LPA observed 5 of 5 residents' bed are sanitary and free from debris. page 1 of 3 see LIC 809C LPA with ADM toured 3 full bathrooms (B1, B2 and B3). B1 is located at the hallway and shared by two resident. LPA observed B1 have non skid mats and grab bars and a bath seat with a broken leg that was tied together by a rope. B2 is used by one resident and has non-skid mats and grab bars. LPA observed that the trash bin inside B2 did not have a lid. B3 is located in a shared bedroom at the end of the hallway towards the back of the property. LPA observed that bath seat has water residue and soap residue. LPA observed that the facility has a wall pull fire alarm system, a smoke alarm and a carbon monoxide alert system that is in good working condition. LPA observed night lights on the hallway. Hallways are free from obstruction. The sliding door going out to the back deck/patio slides easily and free from obstruction. LPA observed ramps and walkways are free from obstruction. LPA observed the backyard area to be free from debris and is maintained. LPA tested the water temperature for kitchen and bathrooms, water temperature was measured at 105.9 degrees F. Dining and kitchen area and living room area were observed to be sanitary and organized. The facility has sufficient supply of perishable food for 2 days. The facility's non-perishable food for 7 days was not sufficient. The fire extinguisher located in the kitchen was last inspected on 1/12/2024. LPA with ADM inspected the back exterior area of the facility. LPA observed that the ramps are free from obstruction, however wooden plank by BR2 sliding door entry way was frayed. LPA observed the screen door for BR3 was frayed. LPA observed the wooden plank on the ramp by BR6 was frayed and dipping when stepped on. LPA observed bed protectors on the clotheslines. The ramps rail were observed to be in good repair and sturdy. LPA reviewed the following documents 3 of 5 resident record and 3 of 4 staff record. 1 of 3 resident have dementia, 1 of 3 has mild cognitive impairment. LPA observed that the following needs and services plan needs to be updated, 3 of 3 are missing signed consent form, 1 of 3 is missing the personal rights form. LPA reviewed staff record and observed the following 3 of 3 staff record. 3 of 3 medical training is up to date 2 of 3 have the updated 1st aid cpr, 3 of 3 did not have a signed Statement Acknowledging Requirement to Report Suspected Abuse of Dependent Adults and Elders (SOC 341A). page 2 of 3 LIC 809C LPA reviewed 3 of 3 resident centrally stored medication record. Medications are properly labeled. LPA and ADM conducted medication review and observed that 3 of 3 resident have missing medication. LPA requested the copy LIC 500, LIC 400, Updated Policy and Procedure, copy of the surety bond. Deficiencies were cited during today's visit per California Code of Regulation Title 22. See LIC 809D. An Exit interview was conducted with administrator Mila Valisto and Licensee Marie Pendar.