Routine inspection·November 14, 2024

Licensing Program Analyst LPA Marcela Yanez and Licensed Progam Manager LPM Romeo Manzano conducted an unannounced annual inspection visit, and met with Mina Abbasvand During the visit, LPA observed 5 residents and 3 staff. LPA explained the purpose of the visit. the facility is approved for 6 non-ambulatory, 1 which may be bedridden, room #2 is designated as bedridden, hospice waiver approved for 2 residents LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 2 restrooms that had grab bars and non skid mats and 3 residents bedrooms. During tour LPA observed a bottle of mouthwash in the bathroom accessible to residents with dementia, LPA suggested to lock in cabinet. While touring the facility LPA observed residents doing activity and other resident reading a book as well as watching television. During inspection LPA observed 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 70 degrees F, and hot water temperature was measured at 120 degrees F in both resident bathrooms and in kitchen sink was 121.0 F degrees. The staff bedroom was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways and ramps and sturdy. Page 1 of 2 Page 2 of 2 LPA observed 2 exit doors leading from bedroom #2 leading to living room and leading to laundry area. ADM stated she will place a sign stating the bedroom should not be used as a passage way for resident privacy. LPA also observed oxygen in bedroom # 1 resident (R1) who is under hospice care with oxygen. LPA advised to post a "oxygen in use-no smoking" sign Fire extinguisher was serviced in 4/18/2024. 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 11/05/24 LPA observed a storage shed with no electrical wiring approximately 12x12 feet in the backyard with a window with a bed, clothing and personal belonging to Staff (S1). S1 was not present during visit. ADM stated the S1 does not live or sleep in the shed only stores his/her belongings. LPA reviewed facility records for 4 staff and 3 residents. 1 of 3 residents with dementia Appraisal Needs and Services was not updated within the last year last updated was 11/4/2022. LPA reviewed 3 resident medications and centrally stored medication records. LPA conducted interviews with 3 staff and 2 residents. Deficiencies cited during today's visit (see 809-D) This report was reviewed with Mina Abbasvand and a copy of the signed report was provided and a copy of Appeals Rights were provided. End of Report