Routine inspection·June 22, 2023

Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Green Acres Manor for the purpose of conducting a Required 1 year inspection. LPA was greeted at the door by Caregiver, Josiane Doignee. Administrator, Elizabeth Lopez arrived 1 hour later. LPA toured the 1 story facility with the Care Giver, Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. However, LPA and Caregiver observed 2 of 2 laundry rooms unlocked and toxins were left accessible to residents in care (See LIC 809D and LIC 812-Observation/Photos). Fire Extinguishers were found to be last charged on December 2022 at the time of the inspection. Smoke Detectors and Carbon Monoxide Detectors sound directly to the Fire Department and could not be tested during the Required 1 year inspection. There are emergency lights in many of the fixtures in the common areas of the facility that come on should a power outage occurs. Hot water temperature measured at 114 degrees, within Title 22 acceptable regulation of 105 to 120 degrees F in ALL resident’s bathrooms while touring facility. 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 foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations at the time of the inspection. There was a supply of cleaners, hygiene products and paper products available for residents in care. All bathrooms designated for residents in the common areas 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. Medications were centrally stored in a locked cabinet. However, during a review of the Medication Orders, LPA observed 2 out of 2 residents did not have a prescribed medication (See LIC 809D and LIC 858) retained . LPA educated the Administrator regarding the importance of having ALL medications centrally stored and dispensed as outlined in Physicians Orders. First Aid kit was inspected and found to be appropriate during the Required 1 year inspection. (Report continued on LIC 809C) LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + or any other infectious diseases in the facility . LPA advised to update the Infection Control Plan and send to Community Care Licensing (See LIC 9102-Technical Violation). LPA discussed the Emergency Disaster Plan with the Licensee/Administrator in detail and determined that an updated Emergency Disaster Plan will need to be sent to Community Care Licensing. During a tour of the facility, LPA observed an Emergency Generator in the front yard. During the Required 1 year inspection, LPA reviewed 7 of 7 resident records. However, during one of the resident file reviews, LPA observed 3 out of 7 resident files did not have a current Reappraisal or an LIC 602. LPA educated the Licensee/Administrator regarding ensuring that Reappraisals are conducted as outlined in regulation (See LIC 9102-Technical Violation) . In addition, LPA observed that 2 residents who are on Hospice did not have the staff training that were conducted with the Hospice agency retained in the facility files (See LIC 9102-Technical Violation) . LPA educated the Administrator regarding the importance of having ALL training records from outside agencies are retained in files. LPA interviewed 7 of 7 residents in care during the Required 1 year inspection. LPA reviewed 4 of 4 staff member files and found insufficient training hours (See LIC 9102-Technical Violation). LPA interviewed 3 of 3 staff members. 3 out of 4 staff members did not have an Active First Aid/CPR card on file (See LIC 809D). LPA requested the following documents to be sent: LIC 500- Personnel Report LIC 308- Designation of Responsibility LIC 309- Administrative Organization Fire Inspection Report Updated facility sketch Liability insurance Control of Property Register of residents Most updated Infection Control Plan Emergency Disaster Plan (Report continued on LIC 809C) 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 was conducted and a copy of this report along with appeal rights were given to the Administrator.