Routine inspection·July 18, 2024

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with staff S1, Hilda Bejar. During the visit, S1 stated there are 88 residents in Assisted Living and 6 residents in Memory Care. Staff S1 stated facility Administrator is on vacation. LPA toured the facility inside out with staff S1, which included the 1st-4th floor, including the basement, which is being used as memory care. LPA and S1 also toured the kitchen, dining room, activity room, restrooms and residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways. 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 114 degrees F in resident bathrooms. Fire extinguisher was serviced in September 6, 2023. The facility was equipped with smoke and carbon monoxide detectors. Sprinkler system last maintenance was on June 27, 2024. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on 5/18/2024. LPA reviewed facility records for 3 staff and 4 residents. LPA reviewed 3 resident medications and centrally stored medication records. LPA reviewed resident R1's medications, while cross referencing the Centrally Stored Medication Log, LPA observed the medication start date for medications M1-M7 was not listed in the centrally stored medication log. LPA reviewed resident R2's medications, while cross referencing the centrally stored medication log. LPA observed the medication start date for medications M1-M4 was not listed in the Centrally Stored Medication Log. Page 1 Out of 2. LPA conducted interviews with 3 staff and 3 residents. While reviewing resident R3’s file, LPA observed a physician fax communication. The form stated R3 had a fall, June 1st, 2024, and was sent out to the emergency room. Staff S1 showed LPA incident tracking log on his/her computer. The log stated the responsible party was contacted, R3's physicians was contacted, and a text was sent to the ADM. Under the section, "Reported to State", the website states no. (Photographs were taken.) Staff S1 contacted facility ADM via phone call, (at 1:30pm), and ADM stated he/she did send an incident report. ADM stated a fax confirmation is in her office. ADM stated she will try to get someone to find the fax confirmation received form. LPA was not given documentation that the incident report was sent to CCL by the end of the annual inspection visit. While touring the facility, LPA observed resident R2's bedroom has quarter sized bed rail. While reviewing R2's records, LPA did not find a doctors order for the bed rails. Staff S2 stated he/she has been working on it with the doctor. Staff S2 reviewed R2's file to find the doctors order but could not provide LPA with the doctors order. Staff S2 stated he/she would send LPA documentation for the bed rails. Deficiencies cited during today's visit. This report was reviewed with S2 Sharon Carollo. A copy of the signed report was provided. Appeal Rights were provided Page 2 Out of 2. END OF REPORT