Routine inspection·August 15, 2023

Licensing Program Analyst (LPA) Alviso, arrived unannounced to conduct a Required -1 Year inspection, on 8/15/23 at approximately 11:05am, and met with Sandra Ambrecht, lead caregiver. Licensee/Administrator Pamela Johnson was notified of LPA's arrival. Facility has an approved dementia plan of operation. There is an approved hospice waiver for one(1) resident. The facility has a required infection control plan. The facility has a required emergency disaster plan. Fire clearance is approved for six (6) non-ambulatory. There are currently six(6) residents in care; One(1) resident is on hospice services. The LPA reviewed six(6) resident files. All files were complete. The LPA reviewed three(3) staff files. All staff have required criminal record clearance. All staff have current First Aid and CPR as required. All staff have training as required. The LPA toured the facility with caregiver Sam. Hot water was checked at 107.9F. All exits were clear and unobstructed. The bathrooms all have grab bars as needed. Showers have mats/non-slip flooring for resident use. Facility has sufficient furnishings for resident use. Facility has sufficient lighting throughout the facility, in resident rooms, bathrooms, and common areas. LPA observed a sufficient supply of food, perishable and nonperishable. Facility had all toxins/disinfectants locked up and inaccessible to residents in care. All medications were locked up and inaccessible to residents in care. Continued on LIC809C.... All postings were up and visible to all as required. Facility had a sufficient supply of hygiene products, paper products, and personal protective equipment(PPE) for use as needed. Fire extinguishers, two(2), were serviced and tagged as required -expires 7/3/24. Per facility fire drill reviews, last drills conducted were Fire & Earthquake, held on 4/1/23 and 6/1/23. All smoke alarms, eight(8), were working properly during the inspection. The carbon monoxide detector was part of the smoke alarm check, one of the hardwired alarms is also a carbon monoxide detector, it was working properly during the inspection. LPA is requesting the following documents be updated and submitted by 9/15/23: LIC308 - Designation of Administrator Responsibility LIC610E-Emergency Disaster Plan (update as needed & submit) LIC400 Handling of Client Cash Resources Copy of Surety Bond if handling cash. Copy of Current Liability Insurance Copy of Updated Infection Control Plan Copy of Administrator Certificate The LPA observed resident room four(4) to have a strong smell of urine odor. The room is rugged, and the resident is incontinent. LPA discussed with the staff regulations on incontinent care, and ensuring the facility is free of urine odors.. The room is rugged, and the resident is incontinent. LPA discussed with the staff regulations on incontinent care, and ensuring the facility is free of urine odors. This deficiency will be cited, 87625(b)(3) Managed Incontinence, Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence, see LIC809D. The following deficiency was 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 with Lead Caregiver Appeal Rights provided to the Administrator.