Routine inspection·March 21, 2024

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required Inspection and met with Caregiver, Rosa Ascencio. Licensee, Leah Archer was available by phone and gave permission for caregiver to sign report. Required postings were observed. Contact information was reviewed. LPA/staff initiated a tour of the facility at 9:00 am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Water temperature in resident's bathroom measured at 114.7 degrees F which is within allowable range of 105 to 120 degrees F. Extra hygiene products and linens were available. Bathrooms had required grab bars. Kitchen cabinet containing cleaning supplies was locked. Medications were centrally stored and locked. Fire extinguisher charged and serviced as of February 2024. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Exit doors have auditory alerts that were functional at time of visit. Last disaster drill was conducted on February 2024. Facility has at least two days of perishable and one week of non-perishable foods. At approximate 9:15am LPA/staff observed one can of dark red kidney beans expired as of May 2023, one can of mixed vegetables expired as of 1/21/2024 and a classic yellow mustard expired as of 5/1/2021. File review was initiated at 9:30 am. Three staff files and five resident files were reviewed. One out of five residents (R1) care plan needs to be updated a technical violation was issued. Also, LPA had a discussion with Licensee via phone about medical assessments and mild cognitive diagnosis because some residents have not been evaluated for a couple years. Licensee agreed to have resident re-assessed by their physician to confirm that they have the same diagnosis, and technical advisory was issued. Staff have required First Aid and CPR certificates. However, one out of three staff (S1) file is missing, but LPA confirmed that S1 has been associated and cleared in Guardian website as of 3/14/24. Licensee confirmed to LPA that S1 just started a week ago, and ensured to LPA that they are only shadowing staff. LPA explained to Licensee that S1 needs to have required documentation on file. Administrator's certificate for Leah Archer 6033354740 expires 12/23/2024. Continued on LIC809C... Continued from LIC809... At approximate 9:45am LPA/staff conducted a spot of medications and their records were reviewed. However, five out of five resident's (R1, R2, R3, R4 & R5) medications were not entered into the Centrally Stored Medication log. Per staff, R2 was hospitalized between March 7, 2024 and discharged on March 12, 2024, but LPA reviewed incident reports for this facility submitted to CCL and the Department was not notified about R2's hospitalization. The following medication prescribed to R2 have not been given as prescribed by their physician: Ezetimibe 10mg (1 tab by mouth at bedtime), Trazadone HCL 150mg (2 tabs by mouth at bedtime), Carvedilol 12.5mg tab (1 tab by mouth twice daily), Lisinopril 40mg (1 tab by mouth daily), tradjenta 5mg (1 tab by mouth daily), start dates of medication had discrepancies with amount of medication on hand. At approximate 10:30am, LPA/staff observed that resident (R2) who is bedridden is occupying room #2, which is not cleared by the Fire Department as a bedridden room. On 1/16/2020, the facility was granted a fire clearance for five non-ambulatory and one bedridden client that could occupy bedroom #1 or 4. However, during the physical tour of the facility and records review of residents in care, it was observed R2 occupying room #2. Licensee is operating outside the limitation of the license by accepting a bedridden resident in a non-ambulatory room. LPA/Licensee discussed the issue with R2 and provide the option to relocate resident to a bedroom cleared by the fire marshal for bedridden residents. Licensee agrees to discuss the issue with R2 to provide R2 with the option to move to a bedroom cleared by the fire marshal for bedridden residents or provide another option to CCL that would allow Bedroom #2 has fire clearance for bedridden residents. According to the licensee, R2 is not bedridden and they will reach out to R2's physician to obtain an updated physician's report (LIC602). During the visit, LPA spoke with R2 who expressed that they are not fully bedridden and they are in agreement to obtain an updated medical assessment. As a result of the fire clearance violation, an immediate civil penalty in the amount of $500 is issued today. Licensee to submit updates of the following documents by 3/28/2024: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500), Emergency Disaster Plan (LIC610E) and a copy of Liability Insurance. 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. Exit interview was conducted over the phone with Licensee who was informed that the Department will be scheduling an informal office meeting to address areas of concerns and overall compliance of the facility and a copy of this report was given.