Routine inspection·September 10, 2024

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by corporate board member, Julia Latifi. Administrator Alex Varshavsky arrived later. At approximately 9:30am LPA toured the building and grounds. The facility was found to be clean and common areas of facility have portable air conditioner and four overhead air conditioner. However, rooms do not have portable air conditioners. Rooms have small fans. LPA discussed with Admin adding a small portable air conditioner for each room, especially during the summer months when temperatures reach over 100 degrees F, as it is probable that fans do not cool rooms under 85 degrees F. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food items were not found to be stored in a safe manner with open items that were not covered and sealed; open loaf of bread with bread pieces spilled on the floor, open and uncovered box of croissants, flour in a metal container covered in plastic wrap labeled 12/12/23, sour cream tub and cream cheese tub opened but not labeled with date (deficiency cited, see 809D). All bedrooms were equipped with night stand, and chest of drawers. Six [6] our of sixteen [16] rooms had lamps present but were not working. Room #2 has a broken bathroom window, LPA found a wooden spoon lodged between window and window sill to keep the window open. Room #8 has a broken window, the inner frame of the window is broken and separated from the glass. Room #10 has a hole in the wall opposite of the beds. ( deficiency cited, see 809D ) . Extra hygiene products and linens were available. Resident bathrooms all had grab bars and anti-slip strips present . The main bathroom did not have required bath mat and community/unassigned towels present. Water temperature in sink accessible to residents in care in main bathroom measured at 105.2 degrees F which is within the allowable range of 105 to 120 degrees F. Continued on 809C... Continued from 809... However, water temperature in sink accessible to resident in room #7 measured at 99 degrees F, in room #8 measured at 84 degrees F, in room #11 at 96 degrees F, in room #12 measured at 97 degrees F, and in room #16 measured at 87 degrees F which are all outside of the allowable range of 105 to 120 degrees F (deficiency cited, see 809D). LPA observed urine on toilet chair in room #2 along with spots of a dried brownish reddish substance. Curtains in room #14 had brown substance in various spots (deficiency cited, see 809D) . Fire extinguishers were last inspected 10/23/2023. Smoke/Carbon Monoxide detectors located throughout the facility are hardwired and serviced quarterly by Nemesis Fire, last serviced on 8/21/2024. Facility’s last quarterly disaster drills were conducted 9/2/2024. Facility has a backup generator for use during a power outage. At approximately 11:30am LPA conducted review of 6 staff records. Five [5] out of six [6] staff did not have at least 20 hours of annual training completed. (deficiency cited, see 809D) . LPA and Admin discussed training materials and the possibility of utilizing an approved vendor for training to complete staff training requirements. Facility will submit current training materials to CCL for approval. At approximately 1:30pm LPA and Med Tech conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. LPA discussed with Med Tech adding date started to bottles and list on Centrally Stored Medication Log as best practices. At approximately 2:30pm LPA conducted a review of 6 resident records. R5 most current appraisal dated 2/1/2023 (deficiency cited, see 809D) . Residents R1, R2, R3, and R4 all have bedridden status but facility has fire clearance for two bedridden residents. LPA and Admin discussed either notifying the local fire department of additional bedridden residents via fax or submit to licensing an updated LIC200 along with an updated facility sketch and CCL will request an inspection to update fire clearance for bedridden allowance. Admin chose to submit an updated LIC200 and facility sketch. Once received CCL will submit to local fire department. Continued on 809C(2)... Continued from 809C... Alex Varshavsky Administrator Certificate 7019479740 expires 7/15/2026. All fees are current as of this time. 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 Liability Insurance 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 .