Routine inspection·February 20, 2024

License Program Analyst (LPA) Hansen arrived unannounced to conduct an annual inspection visit of the facility. LPA was welcomed by Licensee/Administrator, Ladana Luellen. There is a total of 5 residents in care, 2 currently on Hospice, 1 with dementia. LPA toured the facility on 2/20/2024 at 8:45 AM with staff Arthur “Lee” Luellen; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Exits were equipped with auditory devices; (although they were not turned on during today’s visit (see LIC809-D). Smoke detectors and carbon monoxide detectors were found to be operational during the visit. Fire extinguishers were last checked 10/13/2023. Hot water temperature measured between 114.9 degrees F and 118.5 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 3 of 3 resident’s bathrooms while touring facility. The facility serves residents with dementia and has a plan of operation for special care and programming. There was a sufficient supply of both perishable and nonperishable food as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored in a locked cabinet in the laundry room. Dangerous items were found stored inaccessible to residents with dementia. There was a supply of cleaners, hygiene products and paper products available for residents. The bathrooms designated for residents at the facility were supplied with paper towels and hand soap dispensers. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower. All bedrooms have lighting & appropriate furnishings. Medications were centrally stored in locked cabinet in facility office/kitchen. A review of five resident & two staff records as well as medication audit was conducted. LPA reviewed resident’s files at 10:00 AM on 2/20/2024 and learned that 1 of 5 residents (R1) do not have an appraisal or updated re-appraisals/needs & care plan (see LIC809-D) and 5 out of 5 residents physician’s assessments (LIC 602A) are updated as required by Title 22 Regulations on file. Continue on LIC809-C Medications were centrally stored in locked cabinet in the facility kitchen. The Medications of 2 out of 2 residents were found to be given according to physicians’ directions on 2/20/2024 at 11:30 AM. Centrally Stored Medication Record (CSMR) of 2 out of 2 residents were found to be complete and accurate. LPA reviewed a sample of staff records at 11:45 AM on 2/20/2024 and learned that all facility staff present and a sample of other individuals who require caregiver background checks have received criminal record clearances or exemptions. LPA observed during staff file review that facility has proof on 2/20/2024 at 11:00 AM of direct care staff annual training requirements for 2023. LPA was presented with proof of CPR although 1 st Aid certification for Licensee expired. (see LIC 9102 Advisory Notes) Ladana Luellen Administrator Certificate # 6015414740 expires on 4/10/2024. Facility’s last recorded disaster drill was 2/2/2023 falling out of Title 22 Regulations (see LIC809-D). LPA reviewed Licensing Information System (LIS) with administrator who stated that is corrected and updated at this time; no need to change any of the information. In addition, LPA advised facility to check with the County regarding what is the County Emergency Plan; ensure that disaster drills are conducted in different shifts, and review facility emergency plan to ensure accuracy according to the needs of facility residents. Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) and 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. Exit interview conducted and appeal of rights provided LPA Hansen is requesting Licensee to update the following documents by 3/20/2024: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Copy of Administrator Certificate Copy of Certificate of Liability Insurance