Routine inspection·January 31, 2024

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator (ADM) Amarjeet Mann. During visit, LPA observed 6 residents and 2 staff. LPA toured the facility inside out with ADM which included; the Living room, kitchen, dining room, 3 restrooms and 7 residents bedrooms. The staff area of the facility was also inspected. Front yard and backyard were inspected. There was no obstruction to block the walkways. 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 74 degrees F, and hot water temperature was measured at 118 degrees F in both resident bathrooms. Fire extinguisher was serviced in October 9, 2023. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on January 23, 2024. LPA reviewed facility records for 3 staff. LPA reviewed facility resident records for 3 residents. LPA requested resident weight records for R1-R3. ADM stated she only measures the residents weight when they go to their annual doctors visit. LPA reviewed 3 resident medications and centrally stored medication records. While reviewing R2's medication records, LPA discovered discrepancy in medication bottle #1. R2's medication states give two tablets by mouth nightly, with a start date of 12/16/23, and a pill count of 100. LPA reviewed R2's MAR, and there was no refusals. LPA audited the medication and observed only 5 tablets available. ADM does not know why there is an odd number of tablets. Page 1 out of 2. LPA also reviewed Resident R3's medications. R3's medication bottle #1 states take 1 tablet daily, with a pill count of 90. The centrally stored medication log states the medication was being administered starting 12/22/2024. A review of R3's MAR, shows the medication was not refused, and has been administered. An audit of R3's medication showed a total of 53 pills. LPA asked ADM why there was a discrepancy, if the medication began on 12/22/23 ( 10 days of medication administration in the month of December and 31 days for the month of January, 31+10=41) If 41 tablets have been administered, then the medication bottle needs to have 49 pills, because the facility MAR shows zero refusals. ADM stated she is unsure why there is an excess of 4 medication pills. LPA conducted interviews with 2 staff (S1 & S2) and 2 residents (R1 & R2). Deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. Exit interview was conducted with A dministrator Amarjeet Mann and a copy of the signed report & appeal rights were provided. Page 2 out of 2.