Routine inspection·April 16, 2024

Licensing Program Analysts (LPAs) Alviso and Mutialu conducted a Required- 1 Year visit, on 4/16/24 at approximately 8:40am, and met with Licensee/Administrator Bana Solomon. There currently are four (4) residents in care. Facility has an approved dementia plan of operation. There is an approved hospice waiver for six (6) residents. Facility has a required infection control plan. Facility has an emergency and disaster plan as required. The facility does have emergency food, water, and supplies to meet the "72 hour shelter in place" requirements. Facility has a fire clearance approval for a total of six non-ambulatory, of which one (1) may be bedridden. The LPAs reviewed four (4) resident files. All files were complete. The LPAs reviewed five (5) staff files. All staff have criminal record clearance. All staff have current first aid and CPR certification as required. The LPAs toured the facility with the Administrator Bana. The hot water was checked at 114. to 116.6. degrees Fahrenheit , which is within regulation. The fire extinguishers were tagged and serviced as required- expires 2/2/25. All exits were unobstructed. Food supply was sufficient. All bathrooms have grab bars, and non slip flooring for resident use. The facility is well lighted, including all resident rooms and bathrooms. The facility was observed to be at a comfortable temperature. All medications were locked up and not accessible to residents in care. Facility had sufficient furnishings for client use. Continued on LIC809C.. The backyard has outside patio furnishings for resident use, table had a large shade umbrella. Fire exit and walkways in the backyard were clear and unobstructed. There was a sufficient supply of hygiene products, cleaning supplies, and paper products for use as needed. Facility has a sufficient supply of personal protective equipment(PPE). LPA observed sufficient supply of food, perishable and non-perishable food. LPA is requesting the following documents be updated and submitted by 5/16/24. LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to review and update as needed/required) Infection Control Plan (ensure to review and update as needed/required) Copy of LIC400 Handling of Client Cash Resources (include copy of surety bond if handling cash) Copy of Current Liability Insurance Resident Roster Copy of current Administrator Certificate . Per LPA record reviews, five staff out of five staff lacked completed care staff training, consisting of a total of forty hours, this will be cited, HSC 1569.625 (b)(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. see LIC809D. Per LPA record reviews, there was no documentation of quarterly drills being conducted, the Administrator was not able to provide any documentation of having held emergency quarterly drills, on every shift, as required. This deficiency will be cited, HSC 1569.695(c) A facility shall conduct a drill at least quarterly for each shift, see LIC809D. LPAs observed that a resident bathroom's sink had a leaking pipe underneath it, this 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. Continued on LIC809C... LPA's observed that the facility didn't have required "Oxygen in use"signage posted, and there is oxygen in use. This will be cited, Gas and Liquid 87618(b)(3)(B)- Oxygen, “No Smoking-Oxygen in Use” signs shall be posted in the appropriate areas, see LIC809D. LPAs observed that the front door and slider patio door's auditory alarms were not working properly. This will be cited, Care of persons with Dementia 87705(j) -The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident, see LIC809D. LPAs observed that the cleaners, disinfectants , and soaps, were in the garage, no lock on door and/or items listed in locked up, these items were left accessible to residents in care. Storage Space 87309(a)) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients, see LIC809D. LPAs reviewed records, two out of five staff lacked the required HSC medication training. HSC Medication Training 1569.69 (a)(3) An employee shall be required to complete the training requirements for hands-on shadowing training described in this subdivision prior to assisting any resident in the self-administration of medications. The training and instruction described in this subdivision shall be completed, in their entirety, within the first two weeks of employment, 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. Exit interview conducted with Lead Caregiver Ana Herron. Appeal rights given to the Lead Caregiver Ana Herron for the Licensee/Administrator.