Routine inspection (multi-day)·January 11, 2024

Licensing Program Analyst (LPA) Simi Rai arrived unannounced to conduct a continuation of the annual inspection from 1/9/2024 and met with Interim Executive Director, Brenda Ritter. LPA Rai continued the annual inspection with Angel Bustos, Resident Service Director and Patty Cuzia (RDH) Regional Director of Health Services. LPA Rai toured the kitchen and dining room. LPA Rai observed 2 days of perishable food supply and 7 days of non-perishable food supply. LPA Rai observed a delivery of water gallons during visit and facility had water supply in the pantry, emergency supply closet and kitchen. LPA Rai observed daily temperature log of refrigerator and freezer. During visit, LPA Rai continued to review 5 resident files. LPA Rai observed 5 out of 5 resident files not including weight log. Resident Services Director (RSD) Angel Bustos stated the resident files do not have weight log and the staff are not monitoring Assisting Living resident's weight at this time. RSD stated the facility did order and received a weight machine which will accommodate a wheelchair therefore the facility will initiate weight log for Assisted Living residents. RSD stated the facility recently took over as managing group from the previous managing group and the current facility will honor all Admission Agreements signed by residents and resident's families from the previous managing group. RDH stated the new residents signing under the facility will have new admission agreements reflecting the name of the facility. During a random review/audit of Assisted Living resident's medication bottle and LIC 622 Centrally Stored Medication and Destruction Record. LPA Rai along with RSD and Resident Care Coordinator (RCC) counted the tablets from the medication bottles, 4 out of 4 medications prescribed to R1 was given as prescribed by the doctor, but the medication count was not correct. Continuation on LIC 809-C, Page 1 of 3. Page 2 of 3. During a random review/audit of Memory Care resident's medication bottle and LIC 622 Centrally Stored Medication and Destruction Record. LPA Rai along with RSD and RCC counted the tablets from the medication bottles, 7 out of 8 medications prescribed to R2 was given as prescribed by the doctor, but the medication count was not correct. LPA Rai reviewed R2's medical assessment which was conducted on 12/2/2022 and the facility did not have an annual medical assessment on file as R2 has a Dementia diagnosis. RSD stated they were aware in November 2023 of R2 missing annual medical assessment but have not received a medical assessment from R2's physician. During interview with Staff 1 and Staff 2, 2 staff stated residents are given medications prescribed by physician which was reflected on R1-R2's electronic Medication Administration Record (MAR), but the staff do not log the destruction of medication, therefore the count of the medications is not accurate. RSD stated the facility staff will conduct a mandatory in-service to train the staff of medication administration, including accurate record keeping. On 1/9/2024, LPA Rai observed the water temperatures of the resident bathroom sinks in Memory Care and Assisted Living rooms. 9 out of 9 resident bathroom sinks water temperatures ranged from 120.9F - 130.3 F, which is higher than as stated in regulation where the water temperatures for personal use shall be between 105F-120F. IED stated the water heater was not affected during the power outage and the facility continued to have hot water. During visit, LPA Rai observed the common bathrooms located in the Memory Care unit were locked. LPA Rai observed the resident bedrooms located in Memory Care unit were locked. RSA stated resident would use the bathroom and throw excess toilet paper in the bathroom and clog the toilet. RSA stated the resident would go into other resident's bedrooms. RSD and RDH were present during conversation. RDH informed LPA Rai the facility does not have a policy stating the common bathrooms and resident bedrooms in Memory Care unit shall be locked and RDH will ensure the facility staff are not locking the common bathrooms and resident rooms in Memory Care unit. RSD, RDH, RCC and Memory Care Director, Leann Marquez agreed and understood the facility shall not lock the common bathrooms and resident rooms to substitute staff supervision in Memory Care unit. Page 3 of 3. Deficiencies were cited from California Code of Regulations, Title 22 during today’s visit, see LIC 809-D. Technical Violation was provided. Exit interview was conducted with Angel Bustos, Resident Service Director and Patty Cuzia (RDH) Regional Director of Health Services and agreed and understood the report. A copy of this report and Appeal Rights were provided.