Routine inspection·October 19, 2023

Licensing Program Analysts Cuadra and Coppo arrived unannounced to conduct an Annual Required Inspection and met with Licensee/Administrator, Alex Varshavsky. Licensee/owner Julia Latifi arrived later. Facility currently has Hospice Waiver for 10 residents including 2 bedridden residents allowed. LPAs/Administrator initiated a tour of the facility around 9:00am and made the following observations: Facility was a comfortable temperature. Passageways were free from obstructions. Not all resident rooms were furnished per Title 22 regulation 87307(3)(B): room numbers 2,3,4,and 9 all were missing a lamp for each resident, Technical Advisory given. Water temperature in sink accessible to residents in care measured at 102.2 degrees F which is within allowable range of 105 to 120 degrees F. Extra hygiene products and linens were available. Bathrooms had required bath mats and grab bars.Facility has at least two days of perishable and seven days of non-perishable foods. Required postings were observed. At approximate 9:15am LPAs/Administrator observed 4 out 5 fire extinguishers were last inspected 09/28/2022 which is out of compliance per Title 22 regulation 87202(a). Smoke alarms/Carbon Monoxide detectors were tested and operational per fire inspection tag serviced on 02/10/2023. Last fire drill conducted 09/14/2023. At approximately 10:00am LPAs/Administrator started file review of five staff files and ten resident files. 10 out of 10 residents' Care Plans were not signed by a responsible party as required per Title 22 regulation 87463(c). R10 did not have a care plan and their admission agreement was not signed by their responsible party. Also, residents (R7 and R9) who have a diagnosis of dementia, did not have a current medical assessments within the last 12 months as required per regulation. LPAs discussed with Administrator the importance of having care plans, medical assessments, and admission agreements signed. Administrator agreed to update residents' files to be in compliance with Title 22 regulations to avoid further citations. Continued on LIC809C continued from 809.. At approximately 12:30pm LPAs/Licensee found that 5 out of 5 staff members did not have their training records. The records were not maintained or updated. 3 out of 5 staff have required First Aid and CPR certificates. Administrator Certificate for Administrator, Alexander Varshavsky 6052513740 expires 07/03/2023 (pending). LPAs/Licensee had a discussion about staff training record requirements and Licensee agreed to review and update staff records as well as implement organizational system. At approximately 1:30pm LPAs/Administrator conducted a spot check of medications and observed residents' (R2, R11, R12, R13 & R14) medications are been crushed. However, LPAs were informed by Licensee that there are no physician's crush orders on file to crush medications for residents as required per regulation 87465 (a)(5)(D). Also, Centrally stored medication records have not been maintained current as required by 87465 (a)(6). Based on record review, the facility has not contacted a pharmacy to review their medication management at least twice per year as required by regulation H&S 1569.69 (g). At approximately 2:00pm LPAs/Administrator observed facility's resident alert signal does not produce auditory signal loud enough to alert staff when residents need assistance as required per regulation 87303 (i)(1)(B). Administrator provided LPAs a copy of their liability insurance and a copy of current lease. Licensee/Administrator to submit updates of the following documents by 11/02//2023: LIC 308 Designation of Responsibility forms. LIC 500 Personnel Summary 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 conducted with Licensee/owner and a copy of this report was given.