Routine inspection·June 7, 2023

On 06/07/2023 Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced annual inspection to this facility. LPA was met by Edith Rodriguez, Licensee/Administrator (Certificate # 6043273740, expiration 02/15/2023. LPA identified herself and the purpose of the visit upon arrival. A brief interview followed. All required signage was posted. At the time, census was 6, 5 were non-ambulatory, 1 was bedridden and 3 residents receiving hospice services. The facility license was issued for: AGE RANGE 60 AND OVER, TOTAL OF 6. 5 NON-AMBULATORY OF WHICH 1 MAY BE BEDRIDDEN. HOSPICE APPROVED FOR 4. Entrance/exit doors had a functioning delayed egress alert. The tour began in the kitchen/areas. LPA checked the food supply and found that there were enough groceries for 2 days of perishable and 7 days of non-perishable items at this time. Knives were secured in a locked drawer and chemicals were stored in a locked closet and separate from the food supply. Kitchen displayed lidded trash can. LPA observed a sample menu and activities calendar on the refrigerator. The fire extinguisher was last inspected on 10/03/2022 by A.R.F. Fire Extinguisher Company. Enough smoke and carbon monoxide detectors were present to be in compliance. The LPA observed the furniture, furnishings and lighting in the kitchen/dining room, living room, and four bedrooms. All were in compliance. The hot water was measured in the hallway bathroom and found to be 111 degrees Fahrenheit, within the range of 105-120 degrees required. LPA observed that the 2 bathrooms in the house had grab bars and bath mats along with paper towels. LPA inspected the linen supply and found it to be sufficient for the residents in care. LPA observed the 4 bedrooms were also in compliance with 1 displaying the required "Oxygen in Use" sign. The tour progressed to the locked garage, the door displayed a sign that stated "Employees Only." LPA inspected laundry area and second refrigerator where employees stored their meals/snacks. LPA inspected the medications and CSMDR which were located in a locked cabinet in the kitchen. At this time there were no residents being treated for diabetes and injections were not necessary. All medications and were up to date. LPA reviewed storage, dosing, and recording procedures with the facility administrator. First Aid kit was inspected and found to be complete at this time. LPA completed a records review for 3 staff and 3 residents. LPA offered assistance on what to include on the resident pre-appraisals/needs and services plans for hospice residents as hospice residents may sometimes remain a part of their community for years. LPA otherwise found files to be in compliance at this time. According to the California Code of Regulations (Title 22, Division 6), the LPA observed the following deficiency listed on the LIC 809 D. An exit interview was conducted with the Licensee/Administrator, Edith Rodriguez. Copies of the Facility Evaluation Report and Appeal Rights were provided.