Routine inspection·July 30, 2024

On 7/30/2024 at 2:00 p.m.. Licensing Program Analyst (LPA) Maria (Mita) Partoza arrived and conducted an unannounced required 1 year inspection visit. LPA was greeted by 2 staff and administrator Elizabeth Bautista. LPA stated the purpose of the visit. LPA observed a NO SMOKING OXYGEN IN USE sign posted on the exterior of the facility and 2 of 4 resident's room door. ADM stated oxygen is used by resident in room 2 and 4 as needed only. The facility is a Residential Care Facility for the Elderly (RCFE) licensed to serve ages 60 and over 6 non-ambulatory, 1 out 6 may be bedridden and a waiver for 2 hospice care. The facility's has 6 residents (R1 to R6) that have neurocognitive impairment. 2 staff were present at the time of the visit. 6 residents were present at the facility and 1of 6 were in the living/dining area. LPA observed 5 of 6 residents are in the bedroom and 1 out of 6 residents are under hospice care. Based on document review, the facility does not have a waiver for hospice care. At 2:15 p.m. LPA toured the facility inside and outside with ADM, including but not limited to the kitchen, bathroom, dining room, living room, residents rooms, staff room, backyard and walkways. LPA observed the Personal Rights disclosure, Long Term Care Ombudsman (LTCO) and Centralized Complaint and Information Bureau (CCIB) of the CA Department of Social Services (CDSS) prominently posted on the wall, visible to visitors, resident and staff. The temperature inside the home was at 68 to 69.8 degrees F. LPA and ADM toured the 4 bedrooms and LPA observed the rooms to be organized and free from debris and has sufficient storage for resident's personal belongings. Resident's bedroom has a call alarm system to alert staff if assistance is needed. Three resident bedrooms (Rooms #2 and 3) have sliding exit doors that are free from obstruction. 2 of 4 bedroom is shared by 2 residents. LPA observed 6 of 6 residents' bedroom are sanitary and free from debris. page 1 - see LIC 809C for page 2 *due to technical difficulty while saving the document the ADMs signature was not captured. Based on observation R1 who is under hospice care is able to move from side to side, is able to do 1 or 2 activity of daily living such as eating, drinking and stand with assistance. LPA observed that the facility has a wall pull fire alarm system but it is not connected to the fire department emergency line. The facility has a carbon monoxide alert system that is in good working condition. LPA observed night lights on the hallway. Hallways are free from obstruction. LPA observed ramps and walkways are free from obstruction. LPA observed the backyard area to be free from debris and is maintained. LPA with ADM toured 2 full bathrooms and both have non-skid mats and grab bars and a raised toilet seat. The facility stores incontinent supplies and unopened, unused cleaning and laundry supplies are kept in a locked cabinet inside the garage. LPA with ADM inspected the staff lounge inside the garage. LPA tested the water temperature for kitchen and bathrooms, water temperature was measured at 118.9 degree F to 121.9 degree F. Dining and kitchen area and living room area were observed to be sanitary and organized. The facility has sufficient supply of perishable food for 2 days and non-perishable food for 7 days. The fire extinguisher located in the kitchen was last inspected on 3/16/2024. LPA Reviewed 3 of 6 resident's record and observed them to be complete and up to date, including Centrally Stored Medication and Destruction Record (CSMDR). LPA reviewed 2 staff records and observed the record to be updated. The facility's last disaster drill training was conducted 1/3/2024 1/24/2024, 2/10/2024 and 6/10/2024. LPA discussed with ADM hospice waiver requirement, housekeeping and record maintenance. Deficiency is being cited during today's visit per California Code of Regulation (CCR) Title 22, article 87632 (a).See LIC 809D. An exit interview was conducted with ADM Elizabeth Bautista. A copy of the report and appeals rights were provided. Due to technical difficulty, LIC 809C did not save. *due to technical difficulty while saving the document the ADMs signature was not captured. page 2 of 2 end of report