Routine inspection·October 16, 2024

Licensing Program Analyst (LPA) Alviso, arrived unannounced to conduct a Required -1 Year inspection, on 10/16/24 at approximately 9:40am, and met with Sandra Ambrecht, Administrator. Facility has an approved dementia plan of operation. There is an approved hospice waiver for one(1) resident; Currently there is one (1) resident on hospice care. 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 five (5) residents in care. Per file review, quarterly fire/evacuation/emergency disaster drills are being conducted as required. The LPA reviewed five (5) 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 106.7 degrees Fahrenheit. All exits were clear and unobstructed. All exit doors had auditory alarms. Fire extinguishers were serviced as required, dated 7/2/24. Medications were locked up and inaccessible to residents in care. All cleaners/disinfectants were locked up and inaccessible to residents in care. There was sufficient lighting in resident rooms, hallways, bathrooms, and all common areas. LPA observed a sufficient supply of food, perishable and non-perishable. Sufficient supply observed regarding, hygiene supplies, linens, personal protective equipment (PPE), paper products, and disinfectants/cleaners. Common areas were found to be clean and orderly. Resident rooms 1, 2, 3, 4, and 6, were observed to be clean and orderly. Sufficient furnishings observed throughout the facility for resident use. Continued on LIC809C.. LPA is requesting the following documents be updated and submitted by 11/16/24: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E- Emergency Disaster Plan -Review and submit plan if any changes. If no changes, submit last page (write at top which plan) signed & dated of when reviewed and by who. Infection Control Plan- Review and submit plan if any changes. If no changes, submit last page (write at top which plan) signed & dated of when reviewed and by who. Copy of LIC400 Handling of Client Cash Resources (include copy of surety bond if handling cash) Copy of Current Liability Insurance Resident Roster Copy of current Administrator Certificate when received The following deficiencies were observed by the LPA during the inspection: LPA observed resident's (R1) room, #5,to have a very strong smell of urine, in resident's room and bathroom; The resident is incontinent per file review, and interview with staff S1. S1 stated that they are aware the room smells of urine, and has cleaned the room and bathroom daily, but can't get rid of the urine smell. S1 doesn't know if it's the resident's bathroom, toilet, flooring and/or room, such as the resident's rug. This deficiency will be cited, 87625(b)(3) Managed Incontinence- In addition to Section 87611, General Requirements for Allowable Health Conditions, t he licensee shall be responsible for the following: Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence, see LIC809D. LPA observed that there is a outlet with a coveplate missing in resident room #1's bathroom. There is a large dirty, grease spot above the stove range on the kitchen ceiling that needs to be cleaned really well. There is a door in the kitchen where at the top of this door looks to be sheetrock (drywall) crumbling and falling apart. LPA obtained pictures. This deficiency will be cited, Deficiencies 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 with Administrator. Appeal rights given to Administrator Sandra Ambrecht.