Routine inspection·June 10, 2024

Licensing Program Analyst (LPA) Shannan Hansen arrived unannounced to conduct an Annual Inspection and was welcomed by Business Office Mgr. Elizabeth Alfaro, and met with Administrator, John Beltz. Facility currently has 41 Assisted Living residents and 38 dementia residents in memory care. There are 10 residents currently on Hospice. Facility tour/inspection began at 8:30 AM: LPA toured the facility on 6/10/2024 at approximately 8:35 AM with Business Office Manager (BOM) Lizabeth Alfaro and was joined by Administrator John Beltz shortly after; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. The facility has a special care plan of operation and programming for residents with dementia. Fire Extinguisher was found to be last charged on 10/16/2023. Facility smoke detectors with combination carbon monoxide detectors are hard wired and sound directly to the fire station. Smoke/carbon monoxide detectors and fire sprinklers are inspected annually, and inspection records are current with the last inspection being conducted on 4/15/2024. There are emergency lights in many of the fixtures in the common areas of the facility that come on should a power outage occur. Hot water temperature measured between 113.7 degrees F and 128.3 degrees F falling out of Title 22 acceptable regulation of 105 F to 120 degrees F in 5 of 11 resident’s bathroom faucets, all 5 in memory care, boiler was turned down at visit (see LIC809-D). There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations. Menus are available and provided during meals. LPA observed that provisions are made for individuals with special dietary needs; facility keeps a variety of items on the menu, and facility has a board in the kitchen with a picture of the resident & a list of dietary needs. Food is available for residents any time of the day. Continue LIC 809-C There is a daily activity schedule for residents posted. Toxins are stored in a locked housekeeping room; although while touring facility at 9:24am LPA, BOM, and Administrator observed cleaning supplies under both sinks of memory care kitchenettes in cabinets without locks (see LIC809-D) Building Service Director Russell Echeverria informed due to upgrades throughout the facility, locks in this area had not been completed yet. Locks were installed by end of visit. There was a supply of cleaners, hygiene products and paper products available for residents. All bathrooms designated for residents at the facility were supplied with towels and hand soap dispensers when a private room; although at 8:40am LPA & BOM observed in a memory care bathroom an unlocked cabinet with Lidocaine patches, razors, and other cleaning supplies, see pic (see LIC809-D). Items were removed during inspection and locked in resident bathroom cabinets. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower. A sample tour of resident’s bedrooms was conducted, and bedrooms inspected have lighting & appropriate furnishing. The facility has obtained new flooring throughout and paint, Garden Neighborhood dining area has completed construction due to water leak a year ago. File Review began at 11:15 AM: A sample review of five residents & five staff records as well as four resident’s medications was conducted. LPA learned that 5 out of 5 residents have an updated reappraisal/needs & care plan as well as medical assessments. As per sample review of staff records, staff and other individuals who require caregiver background checks have received criminal record clearances or exemptions. 3 out of 3 direct care staff have not completed annual required trainings (see LIC809-D); 1 out of 3 staff (S1) reviewed did not obtain required proof of 1 st Aid certification (see LIC 809-D). Medication Audit began at 10:45 AM: Medications were centrally stored in locked medication carts and in the facility medication room at the facility. LPA observed medications of 4 out of 4 residents were found to be given according to physicians’ directions. Centrally Stored Medication Record (CSMR) of 4 out of 4 residents were found to have all medications entered for residents. Facility uses bubble pack and pharmacy CSMR for all residents at the facility. Continue LIC 809-C LPA reviewed Licensing Information System (LIS) with Administrator who stated that is corrected and updated at this time; no need to change any of the information. Disaster Drills have been conducted monthly and in different shifts with the last one being conducted on 5/31/2024. In addition, John Beltz, Administrator Certificate # 7017264740 expires 9/30/2024. Civil penalties are being assessed for $250. For repeat of same regulation within a 12 month period. Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) and 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 and appeal of rights provided. LPA Hansen is requesting Administrator to update the following documents and to submit to CCL by 6/20/2024: LIC 308 Designated LIC 500 Personnel Summary (already received) LIC 610 Emergency Disaster Plan (if changed) LIC 9020 Register of Facility Resident’s (already received) Copy of Administrator Certificate Copy of Certificate of Liability Insurance (already received)