Routine inspection·December 20, 2024

At approximately 10:30 AM, Licensing Program Analysts (LPAs) Julie Florio and Robert Frank arrived unannounced to conduct a required 1-year annual inspection and were greeted by Mary Ann Ordono, Caregiver/Designated Responsible Party (DPR). Charmaine Mendaros, Administrator was contacted via telephone, gave LPAs permission to begin inspection with DRP, and Administrator arrived approximately one (1) hour later at 11:30 AM. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care. All residents were present during today's inspection. Facility has a hospice waiver for five (5), a bedridden waiver for one (1), is approved for all non-ambulatory residents, and currently has three (3) hospice residents in care. At approximately 10:50 AM, LPAs initiated a tour of the facility with DRP and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. LPAs observed a lock installed near the top of the front door of the facility and advised Administrator to ensure that all facility exterior doors remain in compliance with regulation for a facility not approved for a secured perimeter unless otherwise approved by The Department, (see LIC809D). Administrator removed the lock immediately. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPAs observed a supply of clean linens and hygiene, paper and incontinent care products available to residents. Residents' bedrooms were inspected and observed to have the appropriate furnishings as outlined in Title 22 regulations. LPAs observed mouse droppings in the food pantry and an activated mouse trap in resident bedroom 3, (see LIC809D). Cabinets containing cleaning supplies and other items that could pose a risk were locked. However, LPAs observed the key used to unlock said cabinets hanging on a hook in the kitchen where accessible to residents in care, (see LIC809D). Facility has at least two days of perishable food and an emergency water supply. Continued on LIC809-C... Continued from LIC809C... LPAs advised administrator to increase the amount of non-perishable food/emergency food to ensure facility has at least a one week supply. Additionally, LPAs observed several perishable food items transferred into storage containers that were not labeled with the item name, expiration date, or open date, (see LIC809D). Medications were centrally stored and locked. There is a covered seating area in the backyard with outdoor space for activities. LPAs observed a missing screen door and at least two window screens in disrepair, (see LIC809D). LPAs observed an activity schedule and games, puzzles, and activities for residents in care. Facility hosted their holiday party last night for residents in care. Administrator agreed to purchase an additional internet access device which will be dedicated for resident use and facility has internet service available to residents in care. The facility telephone was tested an operational during inspection. Facility's fire extinguisher was observed charged and was last serviced February 2024. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Facility conducts quarterly disaster drills, and the most recent drill was conducted 10/2024. LPAs observed the facility's infection control plan, first aid kit, PPE, and other emergency supplies. LPAs reviewed facility's emergency disaster plan last updated 11/2021. At approximately 12:30 PM, LPAs reviewed five (5) staff files which all contained the required paperwork including the required CPR and First Aid training certificates. However, Staff 1 (S1) and Staff 2 (S2) were deficient in proof of completed initial training hours, (see LIC809D). LPAs conducted file review of all six (6) resident files and observed two (2) or more of the required documents either missing or not signed and dated from each file, (see LIC809D). LPAs advised Licensee to ensure all documents are complete, signed, and dated. At approximately 3:00 PM, LPA reviewed medications and medication records which are maintained and stored in compliance with regulation. However, LPAs observed expired medications, (see LIC809D). Licensee states facility coordinate sresidents' medical and dental appointments and coordinates their transportation to and from visits with residents' family or a third party transportation service. Facility does not manage cash resources for residents. Continued on LIC809C... Continued from LIC809C... Updated copies of the following documents are to be submitted to CCL within 30 days of this visit : LIC610 Emergency Disaster Plan (updated) LIC500 Personnel Report (updated) Proof of Current Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted with Administrator and Appeal rights were given. Signature on form confirms receipt.