Routine inspection·January 3, 2024

License Program Analyst (LPA) Hansen arrived unannounced to conduct an annual visit of the facility. LPA was welcomed by staff Glenda Castle. Georgiana R Santos Licensee/Administrator was contacted by facility staff on the telephone and wasn’t able to be present for this visit, LPA spoke with Licensee authorizing staff to sign documents. There is a total of six residents, 4 with diagnosis of dementia, 1 resident on hospice. Facility tour/inspection began at 8:45AM: LPA toured the facility with staff Evangeline; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Exits were equipped with auditory devices that were working properly during the visit. The one Fire Extinguisher was found to be last charged on 1/24/2022 at the time of the visit out of Title 22 regulations (see LIC809-D). Smoke detectors and carbon monoxide detectors were found to be operational during the visit. Hot water temperature measured 107.7 degrees F and 108.6 degrees F in 2 out of 2 resident bathroom faucets which are within Title 22 acceptable regulation of 105 to 120 degrees F. 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; although cleaning supplies were stored under kitchen sink with food (see pic & LIC809-D) and were removed by staff. At approximately 9:00am LPA observed in kitchen with staff, broken lock on knife/sharps drawer which is a danger to residents in care (see pic & LIC809-D). Toxins are stored in the garage in a locked laundry cabinet; although on 1/3/2023 at 9:20am LPA observed cleaning supplies w bleach on floor in garage & laundry detergent in uncovered cup in resident bathroom at 9:30am in unlocked cabinet under sink (see pic & LIC809-D) both removed by staff. 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 individual 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. Continue on LIC809-C File Review began at 10:30 AM: A review of six resident & five staff records as well as two resident’s medications was conducted. LPA reviewed resident’s files and learned that 4 out of 6 residents (R1,R2, R3, & R4) do not have an updated re-appraisals/needs & care plans and only 5 out of 6 residents have current physician’s reports. R1 has a diagnosis of dementia and does not have an updated physician’s assessment (LIC 602A) (see LIC 809-D’s). LPA reviewed a sample of staff records 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. Direct care staff annual training requirements for 2023 are on file. LPA was presented with proof of CPR & 1 st Aid certification for staff that files were reviewed. Medication Audit began at 1:45 AM: Medications were centrally stored in locked cabinet in the facility office room area, however; during tour of the facility LPA observed unlocked kitchen drawer containing pre poured medications (see LIC 9102 for technical of pre poured medications). including unlocked mini refrigerator containing resident’s medications (see pic & LIC 809-D). Facility has a 30-day supply of medication for residents. The Medications of 2 out of 2 residents were found to be given according to physicians’ directions. Centrally Stored Medication Record (CSMR) of 2 out of 2 residents were found to be complete and accurate. 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. Administrator Certificate for Administrator, Georgiano Santos 6019796740 expires 8/25/2024. In addition, LPA advised facility to check with the County regarding what is the County Emergency Plan; and review facility emergency plan to ensure accuracy according to the needs of facility residents. Last Disaster Drill was conducted on 12/2/2022 (see LIC 809-D). Disaster drills are to be conducted quarterly and in different shifts. Appeal of Rights Given. Continue on LIC809-C 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 facility to submit the following documents to CCL by 1/25/2024: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Resident’s Copy of Current Administrators Certificate Copy of Certificate of Liability Insurance