Routine inspection·August 8, 2024

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator (ADM) Qui Nguyen. During the visit, LPA observed 5 residents, 1 staff and 1 volunteer. LPA explained the purpose of the visit. LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 3 restrooms and 5 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways. While touring the facility backyard. LPA's observed the facility sheds. LPA observed that behind the shed, closest to the deck, had several tools and a red container of gasoline. (Photograph was taken.) ADM put the tools inside the shed during the visit. LPA's also observed behind the shed closest exit #3 had a container of lighter fluid. LPA's also observed in the facility backyard between both sheds had several dog droppings. LPA's also observed an assortment of wheelchairs, walkers in the deck. ADM stated she plans to move them to storage. 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 78 degrees F, and hot water temperature was measured at 119 degrees F in both resident bathrooms. Fire extinguisher was serviced in July 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 July 9, 2024. Page 1 Out of 2. During the tour of the facility, LPA observed residents bedrooms. LPA observed 4 Out of 5 residents beds had half side rails. LPA requested to see the doctors orders for the bed rails. ADM stated she didn't know she had to get a doctors order for the half side bed rails. LPA reviewed facility records for 3 residents. Resident R2 and R3 have a neurocognitive disorder. R2 physician's report is dated January 25, 2023 and Needs & services plan is date February 7, 2023. R3's physician's report is dated November 5, 2019 and Needs & Services plan is dated June 21, 2023. LPA reviewed 3 resident medications and centrally stored medication records. LPA's reviewed medication by cross referencing the centrally stored medication record and comparing that information with the medication bottles. While reviewing resident R2's medication bottles; LPA's observed that 4 medication bottles were not listed in the centrally stored medication log. While reviewing resident R1's medication bottles; LPA's observed 1 medication bottle was not listed on the centrally stored medication records. LPA's also observed 3 medication that had incorrect information imputed in the centrally stored medication record. LPA reviewed 3 staff records. LPA's requested to review V1's health statement & Health screening documents. ADM stated she does not have V1's health statement & health screening documents. LPA conducted interviews with 2 staff and 2 residents. Deficiencies are being cited during today's visit. This report was reviewed with Administrator Qui Nguyen and a copy of the signed report was provided. Appeal rights were provided. Page 2 Out of 2. END OF REPORT.