Routine inspection·February 14, 2024

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by Caregiver. Administrator Arthur Alcones arrived later. Facility currently has one resident on hospice which is allowable per the facility's Hospice Waiver. At approximately 9:30am LPA and Administrator toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered and labeled. Kitchen cabinet containing cleaning supplies and sharp knives was locked. Per LPA observation and record review, all bedrooms were equipped with lighting, night stand, and chest of drawers. All bathrooms did not have non-skid bath mats, bathroom in room #5 had a mat but the non-skid did not work and would slide with ease once stepped on (deficiency cited, see 809D ). Water temperature in sink(s) accessible to residents in care measured at 118 degrees F which is within the allowable range of 105 to 120 degrees F. LPA and Admin observed bathroom in room #5 did not have grab bars. Per Title 22 regulation 87303(a)(4) Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. (4) Grab bars shall be maintained for each toilet; bathtub and shower used by residents ( deficiency cited, see 809D ). In bathroom #3 the bottom of the sink is cracking and peeling off, a white bath mat was found to have a brown film and was not non-skid. Bathroom in room #1 smelled of urine and brownish yellow pool film of a substance was located on back side of toilet, sticky and yellow film in front of toilet, and spatters of a dark substance on the wall. Also, bathroom in room #5 and room in general had strong smell of urine. Continued on 809C... Continued from 809... Per Title 22 regulation 87303(a)(1) Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition ( deficiency cited, see 809D ). Per LPA observation and record review, main hallway bathroom had smears of a dark brown substance in multiple places on the wall and by the toilet paper roll. LPA and Admin also observed darkened wet pieces of wood under peeling wallpaper present on frame at the bottom of the shower. Sink in main bathroom also needs repair as layers upon layers of caulking harboring a brown and orange-yellow substance. LPA and Admin observed bedroom window sills in rooms not free of dirt and debris. LPA and Admin observed front door knob not to work, the door does not latch shut. LPA and Admin observed electrical wall faceplate broken, leaving outlet exposed. Per Title 22 regulation 87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors ( deficiency cited, see 809D ). At approximately 12:00pm LPA conducted a review of 6 out of 6 resident records. Half rail orders were not on file for R2, R4, and R5. Per Title 22 regulation 87608(a)(5)(A) Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet.(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed( deficiency cited, 809D ). Continued on 809C(2)... Continued from 809C... Fire extinguishers were last inspected 9/15/2023. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Exit doors have an auditory alert system that was functional at time of inspection. Facility’s last quarterly disaster drill was conducted on 2/4/2024. Facility has a backup generator for use during a power outage. Per LPA and Admin observation and record review, residents R4, R5 did not have an admission agreement and R2's admission agreement was not dated by either party. Per Title 22 regulation 87507(a) Admission Agreements (a) The licensee shall complete an individual written admission agreement, as defined in Section 87101(a), with each resident or the resident's representative, if any ( deficiency cited, see 809D ). Per LPA and Admiobservation and record review, residents R2 and R3 did not have a current Physician's Report, most current for both dated 2022. Per Title 22 regulation 87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs ( deficiency cited, see 809D ). At approximately 3:00pm LPA reviewed staff files. S1 did not have Health Screen/TB clearance, CPR/1st aid or complete requirements for training. S1 has been employed since October 2023 so 40 hours is required, only 6 completed. Per Health and Safety Code 1569.625 Staff training; legislative findings; contents (b) (1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training ( deficiency cited, see 809D ). A Health Screen for S1 not available. Per LPA interview with S1, they never completed a Helath Screen. Per Title 22 regulation 87412 (a)(11) Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) A health screening as specified in Section 87411 ( deficiency cited, see 809D ). Continued on 809C(3)... Continued from 809C(2)... Lily Alcones Administrator Certificate 6013178740 expires 3/9/2024; however, certificate is currently in Renewal-Pending status. All fees are current as of this time. At approximately 3:50pm LPA and caregiver conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility Evidence of Liability Insurance Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Licensee. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator and a copy of this report was given.