Routine inspection·July 27, 2024

On 7/27/2024 at 2:00 p.m. Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted an unannounced, required 1 year inspection at the facility and met with the designated administrator (DADM) Annabelle Esperanza. At the time of the visit, DADM stated that licensee/administrator (LIC/ADM) Debra Hall is currently unable to come to the facility due to physical injury requiring rest. The facility is a Residential Care Facility for the Elderly (RCFE) licensed to serve ages 60 and over. 6 may be non-ambulatory. The facility has a waiver for 3 hospice care. The facility's has 4 residents (R1 to R4) that have neurocognitive impairment. 3 staff were present at the time of the visit. 4 residents were present at the facility. 2 of 4 were in the dining area. 2 of 4 residents are in the bedroom and 2 of 4 are under hospice care. At 2:15 p.m.. LPA with DADM, toured the facility inside and outside, including but not limited to the kitchen, bathroom, dining room, living room, residents rooms, 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 78 degrees F. LPA and DADM toured the 4 resident bedrooms and LPA observed the rooms to be organized and free from debris and has sufficient storage for resident's personal belongings. Residents uses an alarm system to alert staff if assistance is needed and a motion sensor alarm on the bed. ADM stated the facility has a night on call staff if a resident is awake, and staff stays with the resident. LPA observed that the facility has a wall pull fire alarm system connected to the fire department emergency line and a carbon monoxide alert system that is in good working condition. LPA observed night lights on the hallway. Hallways are free from obstruction. page 1 of 3 (SEE LIC 809C). LPA observed that each resident room has a door to access the backyard, doors and sliding doors open easily and free from obstruction. LPA observed the backyard area to be free from debris. However, LPA observed the following, screen doors were broken and needs to be replaced, for R1 to R3, the backyard storage shed door was broken. LPA observed that the sliding door base are not flushed to the floor reducing ease of access. LPA observed that 4 of 4 resident room have a half bath. LPA observed non-skid mats and grab bars and a raised toilet seats with handles. LPA with ADM tested the water temperature for kitchen and bathrooms, water temperature was measured at 107.9 degree F. LPA observed dining and kitchen area and living room area were observed to be sanitary and organized. However, the knives were not locked but hidden and obscured by paper shopping bags. DADM stated that the cabinets are currently being changed and locks will be installed once kitchen cabinets installation are completed. LPA observed that the stove was sanitary, however, the vent screen has accumulated residue from oil and dust. LPA observed that the cabinet door under the sink when opened comes off the hinge. The laundry room and cleaning supplies are locked securely inside the water heater cabinet. LPA observed an open electrical ground inside the cabinet utilized as the laundry room, water heater tank, and chemical storage. 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 and maintained on 8/18/2022. LPA observed that some of the medication are in a locked cabinet, however the other half are inside a cabinet that has broken door and lock does not work, therefore, R1 to R4s medications cannot be locked. The facility has a first aid kit that is complete and accessible to staff. LPA reviewed facility record and observed that the disaster training was last done on 2/20/2023. The LIC 500 needs to have specific time and date for each person even when on call, and the LIC 308, needs to be updated. LPA discussed the records with DADM regarding disaster training, LIC 500 and LIC 308. page 2 of 3 LPA with DADM, reviewed 2 of 2 staff record and 3 of 3 resident record and facility records. Staff training records were up to date. Staff records were reviewed with current first aid certifications, clearance and training. Residents files were reviewed to be complete. Residents' medications are labeled and current. Deficiencies are cited during today's visit based on California Code of Regulations (CCR) Title 22. See LIC 809D. An exit interview was conducted with DADM Annabelle Esperanza. A copy of the report and appeals rights were provided. page 3 of 3 end of report