Routine inspection·June 21, 2024

On 6/21/2024 at 1:20 p,m. Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced required 1 year inspection and was met by Administrator (ADM) Rita Garcia and stated the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE) licensed to serve ages 60 and over, capacity for 6 ambulatory of which 6 may be non-ambulatory and 6 hospice waiver. The facility has 6 residents that have mental illness and neurocognitive impairment. 1 of 2 staff were present at the time of the visit. 6 residents were present at the facility. out of 6 is under the age of 60, 6 out of 6 are-ambulatory, 2 out of 6 have mild neurocognitive impairment. LPA and ADM toured the facility inside and outside, including but not limited to the following: Kitchen, dining, laundry, garage, 4 resident room, 1 staff room, 2 bathrooms, backyard and the exterior 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 70 degrees F. LPA observed the kitchen to be organized, and sanitary with working appliances. Knives were kept in a secure locked area and not easily accessible to residents. The laundry area is located in the garage, cleaning supplies and laundry detergents are kept in a secure locked place not easily accessible to residents in care. The facility has 2 days of perishable food and 7 days of non-perishable food. page 1 of 2 (see LIC 809C) LPA inspected the residents' bedrooms and observed 4 out of 4 bedrooms have furniture and closet space for resident's personal belongings, bed frames with mattress and bed linens. 4 Out of 4 resident room is sanitary, organized and are free from debris. LPA observed that the bathroom floors were scrubbed and sanitized. LPA observed the shower curtain in one of the bathroom has brown residue at the bottom. ADM stated the shower curtain will be replaced. During the tour, LPA observed that Bedroom #4 vertical window blinds were in disrepair. The planks were taped and 3 of the planks were split in half and taped together. ADM stated the licensee will be notified that the vertical blinds needs replacement. LPA with ADM tested the water temperature for kitchen and bathrooms, water temperature was measured at 119.7 degree F. LPA with ADM inspected the laundry area and observed washer and dryer are in good working condition. LPA observed that the medication is in a locked cabinet. The facility has a first aid cabinet with first aid supplies and accessible to staff. The side door and sliding door to access the backyard opens easily and 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. The facility is in a compound with two other facility under the same ownership. LPA reviewed facility record and 2 out of 2 staff record, and 3 out of 6 resident records. The disaster training conducted on 6/10/2024. Residents files were complete and updated. Residents' medications are labeled and current. Staff record were up to date with certification and training. LPA reviewed the facility resident roster and 2 out of 6 are under the age of 60. The facility did not submit an exception request and did not submit exception request licensing to admit and retain resident 2 (R2) who is under the age of 60. Deficiencies were cited during today's visit based on the California Code of Regulations (CCR) Title 22, see LIC 809D. An exit interview was conducted with administrator (ADM) Rita A Garcia. A copy of the report and appeals rights were provided. Page 2 of 2 end of report