Routine inspection·April 27, 2023

On 04/27/23, at 9:00 AM, an unannounced annual inspection was conducted by Licensing Program Analyst, (LPAs), Kimberly Viarella and Licensing Program Manager, (LPM) Liza King at Graceful Living at Modesto. These Community Care Licensing representatives identified themselves and the purpose of their visit to the facility administrator designee, Rainileo Clavano, (certificate # 6060066740, exp. 06/24/23) and a brief interview followed. Facility reported census was 3 with 2 hospice and 1 of those being bedridden. Upon inspection the LPA/M noted that noted a census of 5 of which 3 were bedridden based on the LIC 602 and 3 were receiving hospice services. The facility is licensed for 6 nonambulatory and has been approved for a hospice waiver for 3 residents. Residents with dementia were observed to be in care at this facility. The tour began in the kitchen. Knives were secured in a locked drawer. 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. LPM disposed moldy or expired items including by not limited to: green beans, tomatoes, and jarred peaches. Food storage and meal preparations / menu were discussed with the designated facility administrator and staff. LPM took the opportunity to educate staff on proper labeling procedures and the reason for doing so. Resident medications were kept in a locked drawer in the kitchen. Policies and procedures regarding dispensing meds were reviewed and discussed. LPA observed narcotics locked in a refrigerator in the garage. Continues on LIC 809 C The fire extinguisher was last inspected on 06/17/2022, by Stanislaus Fire. LPA/M observed the dining and living room areas. Both had adequate furniture, furnishings, and lighting to be in compliance. The ceiling fan and air vents had and accumulation of visible dust. The tour progressed into the bedrooms. Bedroom 1, at the end of the hall on the left, was in compliance. Grab bars and a bath mat were present in the adjacent private bathroom. LPA observed mold in the shower. Bedroom 2 was in compliance. Bedroom 3 was not in compliance. There were 2 beds and the one closest to the door extended into the doorway, posing a fire hazard. The room also did not have the required night stand(s) or chairs. LPM discovered gas pills and vapor rub in the top drawer of the dresser, which also poses a safety risk to residents in care.. Bedroom 4 was in compliance. LPA/M inspected the second bathroom. Grab bars were present, a bath mat was not, allowing for a potential fall. There was mold in the shower. The LPA took the temperature of the hot water and it measured 148 degrees and out of compliance. The designated facility administrator immediately turned the hot water down. The designated facility administrator led the tour through the locked laundry room and into the garage. At this time, laundry detergents were also locked to ensure resident safety. LPA/M observed that the garage was unorganized with oxygen tanks in serval places and without a warning sign to alert the fire department. This posed a potential hazard to residents in care. Items stored in the garage included but were not limited to: a baby strolled, 4 wheel chairs, dressers, chairs, boxes, clothes, shoes, empty boxes, bed frames, mattresses, a privacy screen, suitcases, assorted medical equipment, food on the floor, and more. LPA/M discussed the dangers of having food on the floor and of having a garage with flammable materials stacked and stored in a disorganized fashion. There were storage cabinets along one wall and each was inspected. One locked cabinet contained cleaning supplies. Others contained dry goods and clothes. LPA/M were shown a freezer where it was observed to contain meat wrapped in plastic without any labeling identifying the product or expiration date. Another refrigerator/freezer unit contained similar items. The LPA/M were led by the designated facility administrator out the side door of the garage. The gate was tested and found to be inoperable. There were two window screens on that side of the house that had holes in them and/or did not fit the window properly. Screens were also missing from the kitchen sliders, the dining room window, the living room window and the second bedroom. Continued LIC 809C. LPA/M observed an unlocked greenhouse in the backyard. It contained fertilizer, pesticides and other toxins. Along the side of the house, LPA/M observed gardening shears, pet food, a gas can, Pine Sol and other debris. A records review was performed for 4 staff and 3 resident files. 4 out of 4 staff files were missing their annual training. All First Aid training was current. The resident files were also incomplete. None of the files included pre-appraisal assessments. 3 of the files had needs and assessments that were dated 04/25/23 and there were no prior assessments included in their files. Personal inventories were not completed upon admittance and were not included. The designated facility administrator was asked to produce the 2 hospice care plans for the 2 residents in care and was unable to do so. Staff reported during interview that pain management was being implemented prior to repositioning, however a review of the Medication Administration Record (MAR) did not confirm that this was happening. An interview with the hospice nurse revealed that training has previously been conducted on pain management regarding repositioning. The facility has been cited on the D page for not following the hospice care plan. The following forms and documents were requested to be updated and submitted to CCL via email to kimberly.viarella@dss.ca.gov by 05/29/2023. LIC 308 LIC 400 LIC 500 LIC 610 All staff training Updated Liability Insurance. According to the California Code of Regulations (Title 22, Division 6), the LPA observed the following deficiencies listed on the LIC 809 D. Civil penalties were assessed during today's visit. An exit interview was conducted with the administrator designee, Rainileo Clavano. Copies of the Facility Evaluation Report and Appeal Rights were provided.