Routine inspection·September 19, 2024

Licensing Program Analyst (LPA) M Cuadra arrived unannounced to conduct an annual required one year inspection, LPA was greeted by staff and Licensee, Evelyn Serrano arrived later. There are currently 5 residents in care. No residents receiving hospice services at the moment. Annual fees are current. Contact information was reviewed. Required postings were observed. LPA/staff toured the facility inside and outside observed the following: the facility was at comfortable temperature with all exits free from obstruction. Some window screens needs to be cleaned (technical advisory was issued). Bedrooms were furnished per regulation. Smoke detectors and carbon monoxide detectors were tested and operational. Fire extinguisher were observed charged and service as of 9/5/2024. Licensee told LPA that the facility have not conducted a disaster drill within the last quarter (technical violation was issued). At approximate 9:25am water temperature in the resident's restroom measured 127 and 134.4 f degrees, which is not within range of 105 to 120 F degrees. Bathrooms have required non-skid surfaces and grab bars. At approximate 9:35am during physical tour of the facility, LPA/Licensee observed 3 litter of liquid soap, spray bottle 32 oz of disinfectant, Clorox bleach 32 oz and other cleaning solution bottles and disinfectants located under the sink were unlocked and accessible to residents. Linens and paper products were available. There was a one week supply of non-perishable foods and two days of perishable foods. LPA/Licensee observed in the refrigerator food not labeled and stored per regulation (technical violation was issued). LPA did not observe any staff encouraging activities to residents in care (technical violation was issued). Per Licensee, the residents are regularly taken to the park, bingo or watch television. LPA/Licensee discussed the importance and requirement to offer and provide daily activities to residents in care. Licensee agreed to re assess their current activity calendar and upgrade it as needed. Medication and medication records were reviewed. Medication was locked. Continue on LIC809C... Continues from LIC809... At approximate 10am LPA initiated file review of five residents and three staff files. Two out of three staff (S1 & S2) do not an additional 20 training hours annually completed. All staff have proof of CPR/1st aid training. Four out of five resident's (R1, R2, R3 & R4) care plan was not reviewed within the last 12 months. All residents have current medical assessment. However, LPA/Licensee discussed the importance to have some of medical assessments updated regularly to ensure that resident's needs have not changed over time. Upon review of administrator information it was revealed that the facility needs to submit a change of administrator to Jocelyn Sebastian #606175940 expires 9/1/2024. However, last annual conducted on 9/15/23 and a case management conducted on 6/10/24; LPA Canela have requested to the facility to submit required paperwork to update the Administrator by not later than 6/19/24, but the Licensee did not submit documentation requested by the Department. Per Licensee, current administrator Lolita P. is a backup administrator and they have an acting administrator Jocelyn Sebastian who is currently recovering from surgery. However, none of the administrator mentioned do have an active administrator certificate as of today yet. LPA reviewed the Department's active/pending lists and there are no evidence that they have submit required documentation. Licensee agreed to appoint a new administrator and send required documentation (LIC 215 Applicant Information, Administrator Resume, Administrator certificate, LIC 500 Personnel Report and LIC 501 Personnel Record) to the Department by not later than September 25, 2024. Licensee agreed to submit the current following documents by 9/25/2024: LIC 308 Designation of Facility Responsibility, LIC 610E Emergency Disaster Plan (if there are any changes) and copy of Liability Insurance. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Appeal rights given. Exit interview conducted with Licensee and copy of this report was given.