Routine inspection·September 17, 2024

Licensing Program Analyst (LPA) Alviso arrived unannounced to conduct a Required -1 Year visit, at approximately 11:50am on 9/17/24, and met with Administrator Erika Molina. Facility has an approved dementia plan of operation. There is an approved hospice waiver for three (3) residents. Facility has an emergency disaster plan as required. Facility has an infection control plan as required. Fire clearance is approved for six (6) non-ambulatory, which includes one(1) bedridden. Facility has required smoke alarms, ten (10), which are also carbon monoxide detectors. Fire extinguishers, three (3) were serviced and tagged as required. LPA reviewed six (6) resident files; Resident files were complete. LPA reviewed five (5) staff files. All staff had required training; All staff had required first aid and CPR certifications. All staff had criminal record clearance s required. The facility was at a comfortable temperature. Hot water was checked at 110.5 degrees Fahrenheit. All exits were free and clear of obstruction. All exit doors had auditory alarms, and they were working properly. Food supply was sufficient. LPA observed sufficient supplies of hygiene products, paper products, disinfectants/cleaners, linens, and personal protective equipment (PPE). All bathrooms had grab bars, and mats/non-slip flooring in showers for resident use. Facility had sufficient lighting in all resident rooms, hallways, bathrooms, and common areas. Medications were locked up and inaccessible to residents in care. All disinfectants/cleaners were locked up and inaccessible to residents in care. Continued on LIC809C.. LPA is requesting the following documents be updated and submitted by 10/17/24. LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to review and update as needed/required) Infection Control Plan (ensure to review and update as needed/required) Copy of LIC400 Handling of Client Cash Resources (must complete the form- include copy of surety bond if handling cash) Copy of Current Liability Insurance Resident Roster Copy of current Administrator Certificate . The following deficiency was observed during facility file reviews: Per LPA's file review, there were no emergency drills documented for 2024, facility failed to comply with H&S Code requirements. Administrator was not able to provide the proof of completing the drills, the drills are done quarterly, in the year. This deficiency will be cited, 1569.695(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill, see LIC809D. 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 Erika Molina. Appeal Rights provided to the Administrator.