Routine inspection·April 11, 2023

Licensing Program Analyst (LPA) Alviso conducted a Required-1 Year visit, on 4/11/23 at approximately 9:35am, and met with Caregiver Claudia Maciel. LPA observed a total of two(2) caregivers on duty. Mary Garcia, Licensee/Administrator was contacted notifying her of the LPA's arrival to the facility. Garcia arrived within 30 minutes of being notified. Facility has an approved dementia plan of operation. There is an approved hospice waiver for four(4) residents. Facility submitted to the Department the required infection control plan. Fire clearance is approved for six (6) non-ambulatory, which includes one(1) bedridden, any resident room may be used for the bedridden (1)clearance. There are five(5) residents in care. LPA reviewed five(5) of five(5) resident files; All resident files were found to be complete. All three(3) staff have criminal record clearance and are associated as required. LPA reviewed three(3) of three(3) staff files. Staff S1 is a Registered Nurse, license is maintained and active. Facility was found to be clean, orderly, and at a comfortable temperature with all exits free from obstruction. All eleven(11) smoke alarms, which are hard wired, were working properly during the inspection. Three fire extinguishers were serviced and tagged as required. Medications were stored and locked making them inaccessible to residents. All toxins and cleaners were stored in locked cabinets, and inaccessible to residents in care. There was a sufficient supply of hygiene products, cleaning supplies, and paper products for use as needed. All exit alarms were on exit doors and working properly. All bathrooms had grab bars, and non-slip mat/flooring for bathing/showering as needed. Facility has a sufficient supply of personal protective equipment(PPE) for staff use as needed. Continued on LIC809C... Per LPA's file review, two(2) out of two(2) staff lack proof of annual training hours having been completed per regulations/H&S Code. This will be cited, Staff training; legislative findings; contents, Personal Care Services-H&S Code 1569.625(b)(2) Required 20 hours annually, consists of eight(8) hours dementia care, four(4) hours of postural supports, restricted conditions, and hospice care, and eight(8) hours, licensees discretion, of other staff training completed-total of twenty(20) hours annually. See LIC809D. Per LPA's file review, two(2) out of two(2) staff(S2 & S3) lacked required annual medication training hours. This will be cited, Employees assisting residents with self-administration of medication; training requirement-H&S Code 1569.69(a) All staff are required to obtain medication training to assist residents with medications. Annual medication training is required by all staff assisting residents with medications. S2 & S3 lacked annual medication training, see LIC809D. Per file review and interview, the facility's last drill was conducted on 8/6/2022, and per Licensee there has not been a drill held quarterly since 8/6/22. This will be cited, Emergency Plans H&S Code 1569.695(c)- A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios, see LIC809D. LPA provided a technical advisory regarding Personnel Requirements -General 87411(c)(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. Two staff have a first aid refresher course , certificates don't have specific information to if it is certification of first aid and when it expires. Training is completed by Relias. Licensee to follow-up and update the records as needed/required with first aid certification. LPA requested the following documents to be sent no later than 4/28/23: LIC 500- Personnel Report, LIC 308- Designation of Responsibility, Updated Emergency Disaster Plan (LIC 610E), Most up-to-date Liability insurance, Register of residents. The following deficiencies were observed (See LIC 809D pages) and cited from the California Code of Regulations, Title 22, Division 6, Chapter 8 of California Regulation. Failure to correct the deficiency(s) and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and a copy of this report along with appeal rights were given to Facility Licensee/Administrator.