Post-licensing visit·April 11, 2023

Licensing Program Analysts (LPAs) Simi Rai and Trang Pham arrived unannounced to conduct a Post Licensing visit. LPAs met with Administrator Elizabeth Bautista and Armando Guba. LPAs observed the following posters posted: If You See Something Say Something, Ombudsman, and residents rights to counsel. There is currently 4 residents living at the facility. LPAs toured the facility inside and outside including the bedrooms, bathrooms, living room, and kitchen. Bedrooms and bathrooms were observed clean. Bedrooms are equipped with proper furniture. Facility is equipped with lights and comfortable light lighting. Bathrooms are equipped with grab bars and nonskid floor. Hygiene items and toiletries are available to the residents. Hot water temperature is maintained at 105.0 degrees Fahrenheit. Centrally stored medications, toxins, and sharp objects were locked and inaccessible to the residents. 2 days worth of perishable food and 7 days worth of nonperishable food were observed. Freezers and refrigerators were observed clean. Facility is equipped with smoke detectors and carbon monoxide detector. Hallways and passageways are free of obstruction. LPAs reviewed 4 out of 4 resident records. Resident's mediations were compared with medication log and physician's order. LPAs observed a printed list of medications which was not signed by a physician. Per (ADM), R3 was admitted at a skilled nursing facility and the family provided the list. Per staff S1, medication has been followed on R3's medication log and S1 and S2 have been initialling the medication log which verifies the medication was given to the resident. S1 stated the medication was given by S1 on the dates with S1's initials. Continued on Page 2. LPAs reviewed 2 out of 2 staff records. LPAs observed the health screening report was incomplete since the TB test results was not provided on the report. There was a chest X-Ray from 2021 for S1 which was not within 6 months of hire date. Per ADM, the hire date for S1 is 3/21/2023. Deficiencies were cited from California Code of Regulations, Title 22 during today’s visit, see LIC 809-D. Technical Violations were provided. This report was reviewed with Administrator Elizabeth Bautista and a copy of this report provided. Appeal Rights were provided.