Routine inspection·June 30, 2023

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required inspection and met with Licensee, Nicholas Ray. There are residents with diagnosis of Dementia and Hospice Services. LPA/Licensee initiated a tour of the facility around 9:55 am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Residents rooms were furnished per regulation. Extra hygiene products and linens were available. Facility has at least two days of perishable and one week of non-perishable foods which appeared to be of quality and stored per regulation. Two fire extinguisher was last serviced December 2022. One carbon monoxide detector in the hallway was tested and properly working. Working auditory alarms are placed on all exits. Disinfectants and cleaning solutions were stored inaccessible to residents. Required postings were observed. Administrator Certificate for Nicholas Ray, 6027071740, expired on 6/23/2023. Administrator is currently on Department's pending List. Medications were centrally stored and locked. At approximate 10:00am water temperature in bathrooms used by residents measured at 124.2 and 126.3 degrees F which are not all within the range of 105 to 120 degrees F allowed per regulation. At approximate 10:15am LPA/Licensee observed fire/disaster drill have not been conducted within the last quarter. LPA initiated file review at 10:30 am. LPA reviewed five residents files and two staff files. All residents files have a current medical assessment and care plans updated within the last 12 months. Staff records have current First Aid/CPR certificates, but they need additional 20 hours of required training. LPA/Licensee discussed previously agreement about additional staff needed to assist residents to meet their needs. Continued on LIC809C... Continued from LIC809... At approximate 11:30am LPA/Licensee during medication review, it was observed that medication start dates records of two out of five residents (R1 & R2) were not entered into the Centrally Stored Medication Records including three out of ten medications for R1 as following: Tamsulosin HCL 0.4mg Cap, Pantoprazole Sod Dr 40mg and Atorvastatin 40mg tab. Three out of four medications for R2: Senna Plus 8.6-50mg, Hydrocodo/APAP 5-325mg and Acetaminophen 650mg ER. Licensee agreed to review and update start dates into the Centrally Stored Medication Records. Licensee agreed to submit updates of the following documents by 7/21/23: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500), Copy of Liability Insurance LIC 610 Emergency Disaster Plan (If changes) and Infection Control Plan (If changes) 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 with Licensee and a copy of this report was provided.