Routine inspection (multi-day)·January 26, 2024

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to continue the required Annual inspection and was greeted by Rafael (Omar) Mendoza, Administrator. Facility currently has three [3] residents on hospice which is allowable per the facility's Hospice Waiver. Hospice plans for all three [3] residents were available, LPA reviewed all three [3] plans. At approximately 9:30am LPA conducted a review of five [5] staff files. LPA observed that staff (S1) did not have a clear TB or chest xray present in file. Additionally S1's Health Screen is dated more than 6 months prior to employment. S1 employed in 2020, Health Screen dated 2018. S2, S3, and S4 had indication that TB skin test was performed but no results in file and chest xray not present. Per Title 22 regulation 87411 Personnel Requirements - General (f) All personnel, including the licensee and administrator, shall be in good health...Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure ( deficiency cited, see 809D ). At approximately 12:15pm LPA, Med Tech (MT) and Health and Wellness Director (HWD) conducted a spot check of medication and medication records. Medication is centrally stored in a locked medication room on the first floor and in med carts stored in the med room. The room contains a refrigerator for refrigerated medications. Narcotics are double locked in the medication carts. Facility currently manages resident medications using EMARs and PCC system. LPA and HWD accompanied MT during afternoon med pass. LPA observed that medications are live poured and med cart remains in control of MT while MT is administering medications to residents. Per LPA, MT, and HWD observation and record review resident (R1) had incorrect expiration and fill dates entered on CSML for their Levothyroxine and Atorvastation prescriptions; resident (R3) had incorrect expiration date entered on CSML for their Metoprolol prescription. Continued on 809C... Continued from 809... Per Title 22 regulation 87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (6)The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes:... (D) The date filled... ( deficiency cited, see 809D ). At approximately 2:00pm LPA reviewed five [5] resident files. LPA observed R2 did not have a TB screen or results in their file, chest xray present but does not mention negative TB or evidence (or lack) of TB. LPA verified with Admin R2 does not have TB screen. Per Title 22 regulation 87458 Medical Assessment (b) The medical assessment shall include, but not be limited to:(1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious diseases or other medical conditions which would preclude care of the person by the facility ( deficiency cited, see 809 ). Rafael (Omar) Mendoza Administrator Certificate 6039775740 expires 6/19/2024. All fees are current as of this time, fee due in February. LPA gave Admin PIN to make online fee payment. LPA and Admin discussed facility's Infection Control Plan. LPA reviewed Infection Control Plan. Per Admin no new updates. 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 Evidence of Liability Insurance Current Lease Transportation Procedures 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.