Routine inspection·November 28, 2023

Licensing Program Analyst (LPA) Hansen, arrived unannounced to conduct an Annual Required Inspection and met with Caregiver, Judith Gonzales. Licensee, Arlinda Gregorio arrived later. Per staff, the facility has four residents on hospice which is allowable per the facility Hospice Waiver, with one exception. There were three staff providing care and supervision to six residents. There are 2 residents currently with a diagnostic of dementia. LPA initiated a tour of the facility at 8:30 AM and made the following observations: Facility was a comfortable temperature with thermostat in hallway reading at 72 degrees F. Passageways were free from obstructions. Resident rooms were furnished per regulation. Water temperature in resident bathrooms measured at 110.6 and 112.6 degrees F, within allowable range of 105 to 120 degrees F in bathroom faucets residents use. Extra hygiene products and linens were available. Bathrooms had required bath mats and grab bars. Kitchen cabinets containing cleaning supplies were locked; although cabinet in laundry with disinfectant supplies was unlocked and Lysol disinfectant was in both bathrooms, accessible to residents in care (see LIC 809-D). Bathrooms also contained cloth, face, hand, and body towels that are now not to be commingled with other residents (see TV9102). Facility has at least two days of perishable and one week of non-perishable foods. Medications were centrally stored and locked. Fire extinguisher was last inspected 9/15 2023. Smoke detectors located throughout the facility and the Carbon Monoxide detector were tested and operational. Exit doors have auditory alerts that were functional at time of visit. File review was initiated at 10:50 AM. Five staff files and six resident files were reviewed. One out of five staff did not have required First Aid and CPR certificates, but completed by end of Annual Inspection. Administrator Certificate for Licensee/Administrator, Arlinda Gregorio 6009780740, expired per Administrator 10/3/2021 and is in the process of recertification (see LIC809-D). Medications and medication records were reviewed. Training records for 2 of 5 staff records reviewed were not up to date per regulations (see TV LIC9102). Required postings were observed. Continued on LIC809C Continued from LIC809 At approximately 1:30PM, LPA reviewed 6 resident records and found 6 of 6 residents to have current physician's reports, signed admission agreements, although Reappraisals & care plans of 4 out of 6 residents were not current or did not exist (see LIC809-D). 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. In addition, LPA advised facility to check with the County regarding what is the County Emergency Plan; ensure that disaster drills are conducted in different shifts, and review facility emergency plan to ensure accuracy according to the needs of facility residents. Administrator informed Disaster Drills are conducted quarterly with the last disaster drill being conducted on 9/1/2023. Appeal of Rights Given. 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 12/19/2023: 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 Control of Property Recent updated Lease Copy of Certificate of Liability Insurance