Routine inspection·February 13, 2025

Licensing Program Analyst(LPA) Alviso conducted an annual inspection, on 2/13/25 at approximately 1:40pm, and met with Tamra Richmond, Business Office Manager. Jose Acumabig, Administrator was not on-site today and available to meet with the LPA. The facility has a required infection control plan. Hospice waiver is approved for ten (10) residents only. The facility has a required emergency and disaster plan. Facility is fire cleared for seventy-five (75) non-ambulatory residents. Fire cleared resident rooms/units are 157-187 on the first floor, and 257-287 on the second floor. LPA reviewed six (6) resident files. All files were complete. LPA reviewed six (6) staff files, including training. Per record reviews, last fire drill was 1/29/25 and last elopement drill was on 9/25/24. LPA met with the Activity Director Shaianne Chantavong, and reviewed the facility's activity calendars; Per review of records, activities are being conducted with assisted living residents as required. LPA observed that all stairwells of the facility had evacuation chairs, to be used as needed for residents in an emergency. There was a sufficient supply of food, perishable and non-perishable. The medications were locked up and stored appropriately as required. Medication narcotics were double locked and counted on each shift. PRN and medication records were found to be accurate, and maintained as required. There was a sufficient supply of personal protective equipment (PPE) to use as needed. Sufficient supply of disinfectants/cleaners, and paper products. All cleaners/disinfectants were locked up and inaccessible as required. Sufficient furnishings for residents use. All hallways throughout the facility had sufficient lighting for residents in care. Fire extinguishers were serviced and tagged as required. All exits were free and clear of obstruction. The facility was at a comfortable temperature for residents in care. LPA observed residents engaged in a facility activity during the inspection. Continued on LIC809C.. LPA is requesting the following documents be updated and submitted by 3/13/25: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan -Update if changes, submit copy and/or copy of last page of annual review completed Infection Control Plan- Update if changes, submit copy and/or copy of last page of annual review completed Copy of LIC400 Handling of Client Cash Resources, include copy of surety bond if handling cash. Copy of Current Liability Insurance The following deficiency was observed during the inspection: LPA checked a resident bathroom sink, and the hot water was checked at 122.9 degrees Fahrenheit, which is not within regulation. Deficiency cited,87303 (e) (2) Maintenance & Operation- Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C), see LIC809D. Deficiency will be 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 Tamra Richmond, Business Office Manager. Evaluation report LIC809/809D and Appeal rights were provided to Tamra Richmond, BOM, for Administrator Jose Acumabig.