Routine inspection·October 17, 2023

Licensing Program Analyst (LPA) Alviso, conduct a Required- 1 Year inspection and met with Lead caregiver Joy Montes. LPA observed another caregiver working, Paul Montes. Administrator Ryanne Tapnio was not available to meet with the LPA. Facility has a required infection control plan. Facility has a required emergency disaster plan. Facility has an approved hospice waiver for two (2) residents. There is an approved plan of dementia care. Fire clearance is approved for six (6) non-ambulatory. The LPA reviewed five (5) client files. The LPA reviewed six (6) staff files. All staff had criminal record clearance as required. LPA toured the facility with caregiver Joy. Hot water was checked at 108.5 Fahrenheit. Fire extinguishers (two) were serviced and tagged as required-expires 10/30/23. The facility was clean and orderly. Carbon monoxide detector was working properly. Exit alarms were working properly. Food supply was sufficient. Sufficient supply of cleaners, paper products, and hygiene products. Sufficient supply of personal protective equipment (PPE). Bathrooms were clean and orderly: Bathrooms had grab bars and non-slip mats/flooring for resident use. Licensee/Administrator to submit the following documents by 11/17/23: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 9020 Register of Residents LIC 610 E Emergency Disaster Plan for RCFE -reviewed & updated as needed Copy of current Liability Insurance Infection Control Plan-reviewed & updated as needed LIC400 Handling of Client Cash Resources, include copy of surety bond. LPA observed the following deficiencies: LPA observed vegetables in the refrigerator that were no longer fresh, and of good quality, some were old and rotting. LPA obtained pictures. Continued on LIC809C... This deficiency will be cited, General Food Service Requirements 87555(b)(8)- All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained, see LIC809D. LPA observed the large cabinet with all resident medications to not be locked, and a metal box in the refrigerator with medications that was unlocked, making all medications accessible to residents, and to staff/individuals that should not have access to the medications. This deficiency will be cited, Incidental Medical and Dental 87465(h)(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication, see LIC809D. Based on LPA's record review, staff #3 lacks first aid certification. This deficiency will be cited,Personnel Requirements-General 87411(c)(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross, see LIC809D. LPA observed a resident room and bathroom with garbage cans without tight fitting lids, one of the garbage cans had a dirty diaper and other items used in cleaning and changing the resident. This deficiency will be cited, Maintenance and Operation 87303(a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors, see LIC809D. Per LPA's record review, staff #2 and #3 lack initial training hours, This deficiency will be cited, as required by H&S Code 1569.625(b)(1) This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training, see LIC809D. Continued on LIC809C... Based on review of records, Staff #2 & #3 lack a health screening report, including TB test and results87411(f)Personnel Requirements – General All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. 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. Per file review and observations, the facility has retained a bedridden resident, R1, but does not have the proper fire clearance as required. This deficiency will be cited, (c) To accept or retain a bedridden person, other than for a temporary illness or recovery from surgery, a facility shall obtain and maintain an appropriate fire clearance as specified in Section 87202(a), see LIC809D. Deficiencies 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. Appeal rights provided to lead caregiver Joy Montes. Exit interview conducted with caregiver Joy Montes All documents left with Caregiver JM for Administrator Ryanne Tapnio.