Routine inspection·July 17, 2024

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit. LPA Rai met Licensee, Irish & Justin Ladwig and stated the purpose of today's visit. LPA Rai observed 2 staff and 6 residents at the facility. At this time, there is 1 resident on Hospice services and facility has a Hospice waiver for 2 residents. During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai observed 1 storage shed in the backyard which was not used as habitual space. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. LPA Rai toured 4 out of 4 resident bedrooms, which had available bedding, drawers, and functioning lights. LPA Rai observed 1 staff room. The facility bathroom had available soap, paper towels, and trash cans with lids. The water temperature in the bathroom sinks ranged from 110.5 degrees F - 110.8 degrees F. The water temperature in the kitchen sink was 110.8 degrees F. Fire extinguisher was observed and inspected on 3/13/2024. Facility smoke detectors and carbon monoxide detectors are in working condition . The last disaster drill was conducted on 4/23/2024. LPA Rai reviewed facility records for 3 staff and 3 residents. LPA Rai reviewed resident R3's file and observed the resident did not have a written order from the physician to use a half-bed rail. Licensee left a message for R3's physician to obtain written order for the half-bed rail. Licensee and Lead Staff stated R3 is not under Hospice or Palliative care. Continuation on LIC 809-C, Page 1 of 2. Page 2 of 2. LPA Rai reviewed resident medications and central stored medication records. LPA Rai observed R2's medication records wherein medication #1 was given to R2 routinely 0.5 tablet a day at bedtime and PRN as needed. The different medication orders have separate bubble pack, so there are two bubble pack for medication #1. The centrally stored medication log had recorded the date the medication #1 routine medication was started on 7/11/2024 but the log does not state when the medication #1 PRN medication was started. Based on the observation of the bubble pack for medication #1 PRN, 13 0.5 tablets are not in the bubble pack which indicated the medication was administered to the resident. The Centrally Stored Medication log did not log if medication was disposed/destroyed under the Medication Destruction Record. The facility staff recorded the medication administered to R2 on the MAR (Medication Administration Record), which indicated the routine medication #1 was given from 7/11/2024 - today 7/17/2024 and the PRN was administered from 7/5/2024-7/17/2024. Based on the medication date filled and the medication administered, the resident should be given 7 doses for routine medication and 13 doses for PRN medication. However, when Licensee, Lead Staff and LPA Rai counted the medication in the bubble pack for medication #1 both routine and PRN, the medication doses given to resident R2 were 21. There is one dose of medication that was given which was not recorded on the MAR. Lead staff stated the medication #1 was started on 7/10/2024 and not on 7/11/2024 as recorded on the Centrally Stored Medication log. Licensee understood the Centrally Stored Medication Log needs to be completed accurately. Deficiencies were cited per California Code of Regulations, Title 22. Technical Assistance was provided. This report was reviewed with Licensee, Irish & Justin Ladwig and a copy of the report was provided. Appeal Rights were provided.