Routine inspection·January 25, 2024

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Staff Member (S1) Abijuan Burchell . During visit, LPA observed 2 residents and 1 staff. S1 called Administrator Sylvester Okoro, via phone, and informed the ADM the purpose of the visit. LPA toured the facility inside out with S1 which included; the Living room, kitchen, 2 restrooms and 5 residents bedrooms. While touring the restrooms, LPA observed a bottle of Lysol all purpose cleaner in the private bathroom, in resident bedroom #2. (photograph was taken). LPA also observed shower curtain rod in the private bathroom was laying on the side, in resident bedroom #2. The shower in the private bathroom, for resident bedroom #2 does not have an attached shower curtain. (photograph was taken. ) LPA observed the private bathroom for Resident bedroom #2 does not have a non-skid mat. While touring the bedrooms, LPA observed an indentation in the hallway opening to bedroom 4 & 5. The indentation can is located on the hardwood floor, with grey duct tape. Resident bedroom #5 is a non ambulatory room. S1 opened the living room closet, and the doors hinges on the top were not attached. When S1 attempted to close the closet door, he/she needed to lift the door. (photographs were taken.) Front yard and backyard were inspected. While touring the backyard of the facility, LPA observed a can of "Henry-Wet patch, roof leak repair", directly outside Room #3's window. (Photograph was taken.) LPA also observed bedroom #4 does not have a sliding screen for the door facing the patio. LPA observed bedroom #3's window screen was not attached and had an opening. LPA observed bedroom #2's sliding screen door was missing as well. LPA observed a sliding screen on top of a table in the patio. (Photographs were taken.) There was no obstruction to block the walkways. Page 1 out of 3 Two day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication closet, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 73 degrees F, and hot water temperature was measured at 115 degrees F in both resident bathrooms. Fire extinguisher was serviced in October 25, 2023. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by S1, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on August 23, 2023. LPA reviewed facility records for 3 residents. While reviewing R1's Needs and services plan, dated April 23, 2021, the form is blank under socialization, emotional, mental, physical, functioning needs. A review of R1's physician report, dated April 22, 2021, states R1 is non ambulatory, and "needs assistance while in bed, as needed during the day while up." According to Title 22 code of regulations, 87705 Care of Persons with Dementia (c)(5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs . While reviewing R2's file, LPA observed R2's physicians report, dated, September 9, 2020. The physician report states R2 has a neurocognitive disorder. LPA reviewed Resident R3 file. LPA observed R3's physicians report, dated November 29, 2022. R3's physician report states R3 has a neurocognitive disorder. R3's Needs and services plan is dated December 23, 2022. LPA asked S1 if there was an updated physician report for R2 and R3. S1 stated what's in the file is what the facility had. LPA reviewed 3 resident medications and centrally stored medication records. While reviewing R1's medication's, LPA observed over 2 dozen medications, not secured in their container. (photograph was taken) LPA conducted interviews with 1 staff (S1) and 2 residents (R1-R2). Page 2 out of 3. LPA requested to review 3 staff files. S1 provided 1 staff file. LPA requested to see 2 additional files. S1 stated that was the only one in the facility. S1 called ADM at approximately 1:07pm. S1 stated he/she spoke with ADM. S1 stated there are no other staff files in the facility. S1 stated the other staff files are in the other home. Deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. Exit interview was conducted with ADM at approximately 3:04pm and stated Staff Member Abijuan Burchell could sign on his behalf and a copy of the signed report & appeal rights were provided. Page 2 out of 2. Page 3 out of 3.