Routine inspection·March 14, 2024

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit and met with Administrator (ADM) Carmen Buno. LPA Rai observed 2 staff and 5 residents at the facility during visit. During visit, LPA Rai toured the inside and outside of the facility with staff (S1). When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai observed 2 shed and they were used for storage and not 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 Rai toured the resident bedrooms. 6 out of 6 resident bedrooms had available bedding, drawers, and functioning lights. LPA observed 6 out of 6 resident bed had half-side rails and 2 residents were under Hospice services. ADM stated the residents do not have doctor's orders for the residents to use half-side rails and was not aware resident's need physician's order for bedrails. LPA reviewed resident's Admission Agreement and on page 22, the facility stated the procedure of obtaining physician's order for bedrails. The facility bathroom had available soap, paper towels, and trash cans with lids. The water temperature in the bathroom sink was 117.8 degrees F. The water temperature in the kitchen sink was 114.8 degrees F . The temperature of the facility was measured at 72 degrees F on t he thermostat. Fire extinguisher was observed and inspected on 02/04/2024. Facility smoke detectors and carbon monoxide detectors were in working condition. The last disaster drill was conducted on 10/4/2023. Per ADM and S1, Administrator conducted a disaster drill in January 2024 but could not locate the document. LPA Rai observed an Emergency and Disaster Plan binder which located all drill records for the past 2 years. Continuation on LIC 809-C, Page 1 of 2. Page 2 of 2. LPA Rai reviewed facility records for 2 staff. 2 out of 2 staff files contained documents from when the building was licensed under a different license. ADM stated the facility hired some of the staff from the previous license when the Department approved their license. ADM stated they retained the old documents and placed them in the file. LPA Rai stated the facilty needs retain documents that are issued from the current Licensee and the previous documentation may not be appropriate. LPA Rai is working with the Licensee since the staff are shared between different facilities. LPA Rai reviewed facility records for 2 residents. 2 out 2 resident files did not contain Consent Form and Personal Rights. LPA Rai reviewed resident medications and central stored medication records for 2 residents. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Administrator (ADM) Carmen Buno and a copy of the report was provided. Technical Violation and Technical Assistance was provided.