Routine inspection·May 22, 2024

Licensing Program Analysts (LPA) Christi Coppo and Jacqueline Macias arrived unannounced to conduct a required Annual inspection and was greeted by Caregiver. Administrator, Josephine Credo arrived later. Facility contact information was reviewed. At approximately 9:30am 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. Food was mostly found to be stored in a safe manner with open items covered: one bottle of Tapatio sauce expired 04/2024, one bottle of sesame oil expired as of 9/18/2022, and opened jar of sardines stored at room temperature in cabinet. LPAs advised caregiver that directions on jar of sardines state to refrigerate after opening. Kitchen cabinet containing cleaning supplies was locked. Kitchen drawer with sharp knives locked. Hole in the kitchen wall by outlet near door exiting to the backyard. All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean, bedroom #2 had a soft spot underneath wood flooring, when pressed upon with weight, floor gives way and sinks in ( deficiency cited, see 809D ). Extra hygiene products and linens were available. Resident bathroom next to laundry room had non-skid mat present but mat had black spots and film underneath mat ( deficiency cited, see 809D ). Both bathrooms in main hallway had required grab bars. Water temperature in sink accessible to residents in care measured at 110.7 and 106 degrees F which is within the allowable range of 105 to 120 degrees F. Fire extinguishers were last inspected 2/19/2024. Smoke/Carbon Monoxide detectors located throughout the facility. Facility’s last quarterly disaster drills were conducted on January 25, 2024. Facility has a backup generator for use during a power outage. Continued on 809C... Continued from 809... At approximately 11:00am LPAs conducted a review of 5 resident records. R1, R2, and R5 have diagnosis of Dementia but their Physicians Reports are dated 2022 (deficiency cited, see 809D) . R1, R2, and R5 did not have any Appraisal Needs and Services Plan (R5 had plan present but not dated at the top of appraisal -note says to see 602, 602 dated 2022) (deficiency cited, see 809D). At approximately 12:30am LPAs conducted review of 5 staff records. S1, S2, S3, S4, and S5 did not have current First Aid/CPR (deficiency cited, see 809D) . S2, S4, and S5 did not have Heath Screen (deficiency cited, see 809D). S3, S4, and S5 did not have Training records available (deficiency cited, see 809D). At approximately 2:00pm LPAs and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet in office. LPAs and Administrator observed medication errors during spot check of R2s medication: Vitamin B12 bubble pack with start date of 5/15/2024 had one tablet missing. Levothyroxine with start date of 5/15/2024 had one tablet missing (deficiency cited, see 809D) . Josephine Credo, Administrator could not provide a copy of current Administrator Certificate or provide copy of email indicating receipt of renewal payment from CCL (deficiency cited, see 809D) .. Facility licensing fees due, LPAs gave caregiver LIS printout with PIN and amount due. . 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, and 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 .