Routine inspection (multi-day)·September 20, 2024

On 9/20/2024 Licensing Program Analysts (LPAs) Simi Rai and Marcela Yanez, conducted an unannounced Annual Continuation inspection from 9/13/2024. LPAs met with Executive Director (ED) Tina Bagheri Tayabeh and stated the purpose of today's visit. During today's visit, LPAs reviewed 10 resident files and 5 at random resident centrally stored medication files and resident medications. During inspection on 9/13/2024, in resident room #1, LPAs observed 3 over-the-counter medications and acetone alcohol in the mirror cabinet in the resident room which was not locked and accessible to the resident R1. Staff S1 stated R1 was on the facility medication management program and facility staff administered medications to R1. Based on review of R1's LIC 602A Physician's Report dated 2/22/2024, R1 is diagnosed with Dementia. During visit, facility staff removed the items and placed them in a locked cabinet in the resident's room. During inspection on 9/13/2024, in resident room #2, LPAs observed 1 bottle of 19 oz Lysol disinfectant spray and 1 bottle of 91% isopropyl alcohol located on top of the bathroom sink which was not locked and accessible to resident R2. Based on review of R1's LIC 602A Physician's Report dated 9/3/2024, R1 is diagnosed with Dementia. During visit, staff S1 removed the item and placed them in a locked cabinet. During inspection on 9/13/2024, in resident room #1, LPAs observed 2 multi-purpose scissors located in the bathroom and in the sitting area in the bedroom. Based on review of R1's LIC 602A Physician's Report dated 2/22/2024, R1 is diagnosed with Dementia. During visit, staff S1 removed the 2 scissors and placed them in a locked cabinet in the resident's room. Continuation on LIC 809-C, Page 1 of 3. Page 2 of 3. During inspection on 9/13/2024, in resident room #3, LPAs observed 1 bottle of Clorox Disinfecting spray, 1 bottle of disinfection bleach, 1 bottle of Lysol Disinfecting spray and 1 bottle of Tide laundry detergent. Staff S1 stated R3 was on the facility medication management program and facility staff administered medications to R3. Based on review of R3's LIC 602A dated 9/28/2023, R3 is not able to administer own prescription medications, R3 is not able to store own medication, R3 is occasionally confused or forgetful. During visit, staff S1 removed 4 bottles of disinfectants and cleaning solutions from R3's room and placed them in a locked cabinet. During inspection on 9/13/2024, in resident room #4, LPAs observed 1 prescribed medication bottle which was filled in May 2024 in the mirror cabinet over the bathroom sink in the bathroom. LPAs observed resident R4 was present in the room during the time of inspection. Staff S1 stated R4 was on the facility medication management program and facility staff administered medications to R4. Based on review of R4's LIC 602A dated 3/18/2024, R4 is not able to administer own prescription medications and is not able to store own medication. During visit, staff S1 removed the prescription medication and personally took the medication into the locked medication room. During today's inspection, LPA Marcela reviewed 5 resident medications and record of centrally stored prescription medications. LPA Marcela observed 2 out of 5 record of centrally stored prescription medications had either the wrong start date written on the record and medications were administered to the resident. LPA Marcela reviewed resident R1's medication, 1 medications had different start dates recorded on Centrally Stored Medication Log and resident's medication bubble pack. Medication N had start date on medication bubble pack was recorded as 8/25/2024 and the start date on the centrally stored medication log was recorded as 8/22/2024. LPA Marcela reviewed resident R2's medication, 1 medication had different start dates recorded on Centrally Stored Medication Log and resident's medication bubble pack. Medication G had start date on medication bubble pack was recorded on 9/9/2024 and the start date on the centrally stored medication log was recorded as 9/10/2024. Page 3 of 3. Deficiencies were cited per California Code of Regulations, Title 22, please see LIC 809-D. Technical Violation was provided during today's visit. Plan of Correction (POC) for Type A deficiency issued during today's visit will be due on Saturday, September 21st 2024 11:59 P.M. Plan of Correction (POC) for Type B deficiency issued during today's visit will be due on Friday, September 27th 2024 11:59 P.M. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Executive Director,Tina Bagheri Tayebeh and a copy of the report was provided. Appeal Rights were provided.