Routine inspection·May 21, 2024

On 5/21/2024 at 8:45 a.m. Licensing Program Analyst (LPA) Maria (Mita) Partoza arrived and conducted an unannounced required 1 year inspection visit. LPA was greeted by 2 staff. Administrator, Mina Abbasvand was not present upon LPA's arrival. Staff contacted administrator and arrived shortly thereafter and stated the purpose of the visit. LPA observed a NO SMOKING OXYGEN IN USE sign posted on the door prior to entering the facility and at appropriate area of the facility. ADM stated no resident in care is currently using oxygen. The facility is a Residential Care Facility for the Elderly (RCFE) licensed to serve ages 60 and over 6 non-ambulatory, 1 out 6 may be bedridden and a waiver for 2 hospice care. The facility's has 6 residents (R1 to R6) that have neurocognitive impairment. 2 staff were present at the time of the visit. 6 residents were present at the facility and 3 out of 6 were in the living/dining area. LPA observed 3 out of 6 residents are in the bedroom and 2 out of 6 residents are under hospice care. At 8:55 a.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) and Centralized Complaint and Information Bureau (CCIB) of the CA Department of Social Services (CDSS) prominently posted on the wall, visible to visitors, resident and staff. The temperature inside the home was at 68 to 69.8 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. Resident's bedroom has a call alarm system to alert staff if assistance is needed. Three resident bedrooms (Rooms #2,3 and 5) have exit doors and are free from obstruction. 1 of 5 bedroom is shared by 2 residents. LPA observed 5 out of 5 residents' bedroom are sanitary and free from debris. page 1 - see LIC 809C for page 2 continued from page 1 LPA observed that the facility has a wall pull fire alarm system connected to the fire department emergency line 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 with ADM toured 2 full bathrooms (B1, B2) and 1 half bathroom (B3). LPA observed B1 to have skid mats and grab bars and a raised toilet seat that that ha a clear tape wrapped on the back seat. LPA observed the tape has moisture and has black spots. ADM stated B1 is used by staff, but residents can use the bathroom if needed and the raised toilet seat is for the residents. LPA observed a crack on the base of the sink faucet of B1. ADM stated the residents does not take showers in B1 and trash bin has lid. LPA observed a storage area inside the B1 with accordion door. The facility stores incontinent supplies and unopened, unused cleaning and laundry supplies. LPA observed a lock on the accordion door. LPA with ADM inspected the staff room. LPA observed the horizontal structure of the window inside the staff room is sagging with the seal peeling off. LPA inspected B2 located on the left side of the facility across room 3, 4 and 5 with ADM and observed that the metal trash bin has lid and has signs of rust at the bottom. LPA inspected the bottom cabinet by the sink and found cleaning supplies such liquid bleach (Clorox), and bar powder cleaner (Comet) one of the cabinet door stays locked and one can be opened to access personal products such as lotions, and liquid bath soaps used by residents. LPA observed the bleach was easily accessible at the time of inspection. LPA tested the water temperature for kitchen and bathrooms, water temperature was measured at 109.2 degrees F to 110.9 degree 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 and non-perishable food for 7 days. The fire extinguisher located in the kitchen was last inspected on 8/29/2023. Page 2 see LIC 809C page 3 LPA and ADM inspected the laundry area. LPA observed the laundry area has a curtain, washer and dryer are in good working condition, the laundry area has a cabinet above that does not have a lock, and contained laundry detergents. LPA with ADM inspected the medication cabinet. LPA observed the medication room is locked and is not easily accessible. LPA observed first aid kit inside the medication cabinet. LPA observed a staff in the kitchen during the time of visit and staff showed LPA that knives and sharp are locked after use. LPA reviewed facility record, 3 out of 3 staff record and 3 out of 6 resident record. Facility's fire drill training conducted on 1/15/2024, facility records are up to date. Staff training records were up to date. Staff records were reviewed with current first aid certifications, clearance and training. Residents files were reviewed to be complete. Residents' medications are labeled and current. Deficiencies are cited during today's visit based on the California Code of Regulations (CCR) Title 22, see LIC 809D. An exit interview was conducted with administrator Mina Abbasvand. A copy of the report and appeals rights were provided. end of report page 3