Routine inspection·May 18, 2023

Licensing Program Analyst (LPA) Alviso, arrived unannounced to conduct a Required -1 Year visit, on 5/18/23 at approximately 9:30am, and met with Licensee/Administrator Ami Kumar, and Janine Sorenson, facility Administrator. Facility has an approved dementia plan of operation. There is an approved hospice waiver for three (3) residents. The facility has an infection control plan, and submitted required plan to the Department. LPA discussed with the Licensee and Administrator to review the newest PIN 23-12, and ensure to update infection control plan as/if needed. Submit a copy when the plan has been updated. Fire clearance is approved for six (6) non-ambulatory, which includes one(1) bedridden. The LPA toured the facility with the Licensee and the Administrator. The hot water was checked at 110.F which is within regulation Fire extinguishers(3 of 3) were serviced and tagged as required, expires 2/6/24. All exits were free and clear of obstructions. Facility was found to be clean, orderly, and at a comfortable temperature. Toxins/cleaners are stored in locked cabinets. All exit alarms were on exit doors and working properly. All bathrooms had grab bars, and non-slip mat/flooring for bathing as needed. Required postings were up and visible. LPA observed a sufficient supply of perishable and non-perishable food, emergency food & water supplies, hygiene supplies, cleaners, and paper products. LPA observed a sufficient supply of personal protective equipment(PPE). The LPA reviewed four(4) staff files. All staff have required criminal record clearance. All staff have required current First Aid certification, including CPR certification. LPA reviewed required staff training. Continued on LIC809C... The LPA reviewed five(5) of five(5) resident files. All resident files were complete. Licensee/Administrator to submit updates of the following documents by 6/18/2023: LIC 500 Personnel Summary Copy of Liability Insurance LIC 610 Emergency Disaster Plan (If changes) Infection Control Plan (If changes) During the tour of the facility, the LPA observed a prescription medication bottle in a resident's(R2) room on a tray table, the resident can't handle their own medications, per file review. The medications are required to be crntrally stored, the facility also has dementia residents in care. This deficiency will be cited, 87465 Incidental Medical and Dental Care (h)(2) The following requirements shall apply to medications which are centrally stored: Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally s tored medication. see LIC809D. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Appeal rights were provided.