Routine inspection·June 14, 2024

Licensing Program Analysts (LPAs) Christi Coppo and Jacky Macias arrived unannounced to conduct a required Annual inspection and was greeted by Caregiver. Angelica Martinez, Administrator arrived later. At approximately 9:15 am LPAs and Admin toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPAs observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Some food items were found to be expired or showing signs of expiration such as: Several heads of cauliflower found to have several brown and black spots, sandwich bag containing black avocado, bag of tomatoes with 3 tomatoes showing black spots and white rings, applesauce pouches with expiration date of 5/31/24, head of cabbage/lettuce in bag with brown liquefication, box of snack packs of jello with expiration of 5/17/24, and open items in refrigerator covered but not labeled with a date of opening.( deficiency cited, see 809D ). Kitchen drawer with sharp knives locked. Sharps container containing sharps was left open on the kitchen floor and accessible to residents ( deficiency cited, see 809D ) . Toxins stored in garage in secured cabinet. LPAs noticed 3 rat traps present in the garage. All bedrooms were equipped with lighting, night stand, and chest of drawers, however lamp in room 3 does not work. All bedrooms were clean. Bedroom #3 did not have electricity. Per LPA conversation with caregiver, the electricity has been out for 2-3 days. Per LPA conversation with Admin, they said they were not aware of any outage in room #3 ( deficiency cited, see 809D) Extra hygiene products and linens were available. Resident bathroom had required bath mat and grab bar. Water temperature in sink accessible to residents in care measured at 105.5, 111, and 106.7 degrees F which is within the allowable range of 105 to 120 degrees F. Fire extinguishers were last inspected 9/15/2023. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drills were conducted 2/15/2024. Facility has a backup generator for use during a power outage. Continued on 809C... Continued from 809... At approximately 11:00am LPAs conducted review of 5 staff records. S1 did not have a Health Screen in file. Per LPA conversation with Admin, Health screen for S1 was not available ( deficiency cited, see 809D ). At approximately 12:00pm LPA conducted a review of 6 resident records. All required documentation present. Per R1's Physician's Report and Appraisal Needs and Services Plan, R1 is bedridden. However, facility license does not show non-ambulatory bedridden status. Facility to submit to CCL an updated LIC200 requesting updated license with non-ambulatory bedridden status. LPAs advised Admin to submit LIC200 to CCL no later than 10 business days from 6/14/2024. Per LPAs review of residents files, R1 and R2 require two person assists per Physician's Report and Appraisal Needs and Services Plan. However facility only has one NOC shift employee scheduled per NOC shift ( deficiency cited, see 809D ). At approximately 1:30pm LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a secured office. Per LPA conversation with Admin, medications are pre-poured ( deficiency cited, see 809D ). LPA advised Admin that medications can be prepared at the beginning of the day for the current day. Angelica Martinez Administrator Certificate 7000290740 expires 4/10/2025. All fees are current as of this time. LPAs and Administrator discussed facility's Infection Control Plan and Emergency Disaster plan. No new updates. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report, LIC308- Designation of Responsibility, and current 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 .