Routine inspection·October 28, 2024

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced annual inspection visit at 9:15 AM and met with Administrator, Bradley Burgoyne. LPA toured the facility inside and out with the Administrator to include the resident dining room, kitchen, resident bedrooms, bathrooms, and exterior. Facility temperature maintained between 71 to 72 degrees F. Facility staff are fingerprint cleared and associated to facility. All emergency exits were observed to be clear of obstruction. LPA toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. Refrigerator temperature maintained at 35 degrees F and freezer maintained at -1 degrees F. The exterior of the facility was also inspected. No toxins, chemicals or items that can pose a danger to residents observed. LPA Tarin toured 7 resident bedrooms. 7 out of 7 resident bedrooms had functioning lights, storage space for personal belongings, clean bedding, a chair, lamp and dresser/table. LPA measured hot water temperature, with a range of 113.7 to 114.2 degrees F for 7 out of 7 resident bathrooms. The facility was equipped with smoke and carbon monoxide detectors, and last serviced on 10/24/2024. Fire extinguishers were last serviced on 04/23/2024. LPA observed the facility first aid kit and it was observed to be complete. The facility fire/earthquake drill log was reviewed and drills are being conducted quarterly. The last fire drill was conducted on 09/24/2024. Facility has emergency disaster plan. LPA reviewed 7 residents Centrally Stored Medication and Destruction Records (CSMDR). LPA observed 7 out of 7 CSMDRs are complete with all medications accounted and documented. LPA observed the medication storage area was locked and inaccessible to residents in care. Please see LIC 809-C. LPA reviewed 7 resident records. LPA observed 5 out of 7 resident records as complete to include a physician's report,TB result, updated appraisal/needs and services plan, identification and emergency contact information, personal rights, and consent forms. Resident (R2 and R3) records did not contain updated physician's reports. Resident R2 and R3 physician's reports were not updated within the year. R2 and R3 have neurocognitive disorder. LPA advised Administrator to obtain updated physician's reports for Residents R2 and R3. LPA reviewed 8 staff records. LPA observed 8 out of 8 records to include fingerprint clearance, health screening, TB result, and personnel record. 3 out of 8 staff (S2, S6, and S7) records did not contain CPR/first aid training. LPA advised Administrator that staff who assist residents with personal activities of daily living shall receive appropriate training in CPR/first aid. Deficiencies were cited today per California Code of Regulations, Title 22. See LIC809-D. Exit interview was conducted with Administrator Bradley Burgoyne. A copy of this report was provided to Administrator and Appeal Rights were provided.