Routine inspection·April 24, 2025

Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to conduct the facility's required 1 year annual inspection. LPA met with Administrator (ADM), Nicholas Inneh. During visit, LPA toured the facility with ADM to include the resident bedrooms, bathroom, shower room, kitchen, hallways, dining room, and exterior. All fire exit routes were free and clear of obstruction. Medications, disinfectants, sharp objects observed locked. Staff present are fingerprint cleared and associated to the facility. The facility has an activity calendar, laundry schedule, shower schedule, and personal rights form posted in the hallway. Facility temperature maintained at 69 degrees F. Resident bedrooms contains adequate lighting, beds, linens, dressers/closet space, and a night stand. Facility has at least 7 days worth of non-perishables and 2 days worth of perishable foods. The kitchen is equipped with 2 refrigerators which were maintained at 30 degrees F and the 2 freezer temperatures maintained at 0 degrees F. Items inside the refrigerator observed covered. LPA recommended to clean, de-clutter, and organize the kitchen and pantry. LPA did not observe any rodents or insects in the kitchen during visit. Hot water temperature in the bathroom maintained at 111.4 degrees F. Facility has an operable carbon monoxide and smoke detector. Fire extinguishers last serviced on 04/19/2024. Facility has a sprinkler system. Emergency disaster plans posted next to the exit doors. The facility has emergency flood lights in each hallway in case of a power outage. The last emergency drill was completed on 01/15/2025. Facility has a first aid kit located in the medication room. See LIC809-C. LPA reviewed 3 resident files. 3 residents records observed complete to include an admission agreement, updated physician's report, TB result, updated appraisal/needs and services plan, consent form, safeguard of personal properties/valuables, personal rights, centrally stored medication record, and cash resources. 2 out of 3 resident's has cash resources which was inspected with the ADM and observed complete. LPA observed there are no start dates on the resident's CSMR or on the medication bubble pack/bottle. LPA observed the facility is not maintaining the resident's medication administrator record (MAR) as the last input was dated on 04/19/2025 and some medications were not listed on the MAR. ADM was advised. During the medication inspection, LPA observed 1 resident was not provided their daily routine medication from 04/08/25 - 04/23/25 because the resident was out of medication. ADM states they had called the pharmacy and doctor the 2-3 days before the resident's medication ran out. ADM called the doctor during visit and found the resident's medication was already refilled and delivered to the facility on 04/23/25. LPA reviewed 5 staff files. 5 staff records observed complete to include health screening, TB result, personnel record, and fingerprint clearance. 2 out of 5 staff has an active 1st aid certification. 5 staff are provided annual training in compliance with Title 22 regulations. ADM is informed of a late/outstanding balance of the facility's annual licensing fee that was due on 04/13/2025. ADM was informed about the Department's Technical Support Program (TSP) as a resource for medication administration. ADM is familiar with the TSP website on cdss.ca.gov. 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 were provided.