Routine inspection·May 30, 2024

Licensing Program Analysts (LPA) Christi Coppo and Jacqueline Macias arrived unannounced to conduct a required Annual inspection and was greeted by Staff. Administrator Jeannette Kinney was not available, but LPAs contacted and Admin indicated Tina Worden, Health and Wellness Director (HWD) has signing permissions. HWD arrived later. Facility contact information was reviewed. At approximately 10:15am LPAs and HWD 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. Food was found to be stored in a safe manner. LPAs observed cereal bag not properly sealed; open and exposed. English muffins were not properly stored in the bag; open and exposed. Ice cream tubs were not covered but stored in a covered ice cream freezer. White granular substance was stored in a plastic container with plastic “cling” wrap but without proper lid. Avocados were stored inside the refrigerator without being placed in a Ziploc or plastic wrap. Jello cups were stored on a tray but open and exposed without plastic wrap covering the cups. Container underneath the garbage disposal/sink area had food waste. All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Water temperature in sink accessible to residents in care measured at 116.9 F in community bathroom downstairs, 117.1 F in room #30, 119.1 F in room #68, 117.2 F in room #40, which are all within the allowable range of 105 to 120 degrees F. Fire extinguishers were last inspected 10/30/2023. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational as indicated per Fire Safety Supply's Inspection, Testing, and Maintenance Report dated 12/27/23. Facility’s last quarterly disaster drills were conducted on 5/2/2024. Continued on 809C... Continued from 809... At approximately 12:00pm LPAs conducted a review of 5 resident records. All required documentation present. At approximately 1:00pm LPAs conducted review of 5 staff records. S1, S2, S3, S4, and S5 have no 1st AId/CPR, Health Screen, or Training records on file (respective deficiencies cited, see 809Ds) . At approximately 3:00pm LPAs accompanied Med Tech on afternoon med pass. LPAs observed Med Tech to live pour medications and medication cart remained locked when out of Med Tech sight. Medication is centrally stored in a locked cabinet. No deficiencies Jeannette Kinney Administrator Certificate 7016943740 expires 8/12/2024. All fees are current. LPA and HWD discussed facility's Infection Control Plan and Emergency Disaster plan. No new updates. On 2/26/2024 CCL received an Incident Report indicating a resident R1 eloped on 2/22/2024. At approximately 5:20pm it was discovered that R1 was not accounted for in the dining services area. Per review of the Resident's Physician's Report, resident not able to leave facility unless escorted by family. The facility initiated elopement protocol. At 7:10pm the Health and Wellness Director received a call from EMS indicating they had found R1 and transported them to the hospital for safety. R1 was checked at the ER for injury, infection, and R1 returned to the facility at 9:30pm. Per incident report facility implemented 1:1 caregiver with R1 for safety. Resident then moved to a different facility and no longer resides at facility. On 5/3/2024 CCL received an Incident Report indicating there was a medication error as pertains to resident R2 on 4/16/2024. At approximately 7:30pm on 4/16/24 staff on duty gave R2 a dose of Nitrofurantoin and one dose of Phenazophyridine in error. These two medications were received and entered under the wrong resident's profile. The error was discovered during the shift change. Nurse immediately reported the error. Continued on 809C(2)... Continued from 809C... Per Incident Report, resident did not have any adverse reaction or side effects from medication error. PCP notified by phone and responded that medical treatment was not necessary. R2 was placed on monitoring and increased safety checks for 72 hours. Per Incident Report, staff that made the error received formal counseling and training with Health and Wellness Director (HWD). Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility 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 HWD. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with HWD and a copy of this report was given