Post-licensing visit·July 26, 2023

On 07/26/2023 at 9:40am, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a Post-Licensing Visit. LPA Pascua was met by staff members, Amore Silva and Myrna Cablco. LPA Pascua asked the staff members to go ahead and call the Facility Designated Administrator (FDA), Tabitha Antonia and inform her that CCL was present at this time. LPA was informed that FDA Antonia was unable to come to the facility at this time due to another appointment. Shortly after, LPA met with Facility Designated Representative, Maribel Armada. At the end of the visit, LPA was able to meet with FDA Tabitha Antonio. This facility is licensed to serve and retain 6 residents who are 60 or older. All of which may be non-ambulatory. This facility also holds a Dementia Program on file and has a Hospice Waiver for 6. Current census was 4. LPA reviewed 4 resident files. It was learned that 1 out of 4 residents are currently obtaining services from home health. 3 out of 4 resident files were incomplete. 3 out 4 resident files did not have a Pre- Admission Appraisal. 2 out of 4 residents did not have a current appraisal on file. LPA reviewed 2 staff files. 2 out 2 staff files were complete and up to date. LPA reviewed Medication Administration records. It was observed that all 4 resident's Medication Administration records were not signed for today's AM medication. It was observed that 1 out of 4 residents did not have medication initialed for administration from 07/23/2023-07/26/2023. It was observed that 2 out of 4 residents did not medication initialed for administration from 07/24/2023-07/26/2023. Based on interviews conducted it was learned that medication was provided during these times and staff did not initial the Medication Administration Records (MARs) during the time of administration. LPA conducted a tour of the facility. The fire extinguisher, located in the kitchen area, was serviced by Jorgenson Company on 02/06/2023. Carbon Monoxide and fire alarms were present and in good repair. Common areas for resident use were toured. Furniture and furnishings were observed to be present and in compliance. A tour of the bathrooms was conducted. Hot water temperatures were taken to ensure that the hot water being dispensed was within the allowed range of 105-120 degrees at this time. Grab bars were present and functional. Resident bedrooms were toured. Furniture and furnishing were observed to be present and in good condition. A linen closet was located in the hallway. LPA observed a sufficient amount of linens at this time. The kitchen area was toured. Facility freezer and refrigerator showed to be functional and in compliance at this time. A tour of the pantry was conducted. LPA observed that there was a 2 day perishable and 7-day nonperishable food supply at this time. Garage area was toured. Laundry detergent and cleaning supplies were locked and made inaccessible at this time. First aid kit was observed to be present and contained all of the required components at this time. The exterior of the physical plant was toured. Perimeter fence was observed to be stable and gates were in good repair with no hazards present. The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Code. An exit interview was conduct, a copy of this report and appeal rights were printed and a copy was given to the facility.