Routine inspection·May 10, 2023

Licensing Program Analysts (LPAs) Christine Dolores and Tracy Pham arrived unannounced to conduct the annual inspection. LPAs met with Administrator, Nicholas Inneh. During visit, LPAs toured the facility with staff to include the kitchen, hallways, resident rooms, bathrooms, shower rooms, and dining room. Bedrooms observed with bedding, linens, lighting, night stands, and dressers. Disinfectants observed secured. LPAs observed the shower room was dirty with orange rust stains on the shower walls and floor. Administrator was advised to ensure the bathing facilities shall be clean and sanitary. LPAs observed staff cooking meals in the kitchen. Facility has 7 days worth of non-perishables and 2 days worth of perishable foods. All foods observed with a lid and labeled. Facility is equipped with a lidded trash bin and fire extinguisher. The fire extinguisher was last serviced on 04/13/2023. Hot water temperature maintained at 120 degrees Fahrenheit. 4 resident records were reviewed to include: physician's report, TB information, appraisal needs and services plan, emergency contact information, consent forms, personal rights, centrally stored medication records destruction log, and safeguard of cash resources. Medications and cash resources observed secured. LPAs observed 1 resident (R1) did not have a TB result on file. It was observed the residents appraisal needs and services plans were not signed. Administrator stated the needs and services plans were recently updated and stated a plan to obtain a signature from the resident and/or responsible party. It was observed the resident's physician's reports were not up-to-date with reports last updated in year 2013 and 2016. Administrator states the resident's doctors see the residents frequently, however, they have not updated the physician's report. Administrator was advised. SEE LIC809-C. The facility did not maintain staff records at the facility. Administrator states the Licensee has it stored at another location. LPAs was not able to review any staff records to include first aid certification, training records, and other related personnel records. Administrator was advised. Facility has an emergency disaster plan. Posters observed to include if you see something say something, ombudsman, personal rights, and other COVID related posters. 5 residents and 4 staff were interviewed during visit. During interview, it was stated the facility did not have activities to provide throughout the day. Administrator was advised. Deficiencies were cited per California Code of Regulations, Title 22. See LIC809-D. This report was reviewed with Administrator, Nicholas Inneh and a copy of the report and appeal rights was provided.