Routine inspection·October 26, 2023

On 10/26/23 at approximately 9:40am Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a required 1 year annual inspection. LPA Jensen met with Administrator Shirley Tudence and explained the purpose of today's visit. The administrator holds current certificate # 6057838740 good through 11/9/2024. The current facility census is 4. The facility's plan of operation allows for care of residents with dementia. The fire clearance allows for a capacity of 5 non-ambulatory residents. There is currently no hospice waiver. The annual licensing fees are current. The facility maintains liability insurance for the required policy limit minimums with a current policy period of 3/14/23 through 3/14/24. All facility staff were determined to have criminal background clearance. LPA Jensen toured the grounds and observed them to be maintained with all paths free of obstruction. All window screens were observed to be in good repair. There is outdoor furniture and shaded seating areas for clients to engage in outdoor activities. The facility exit/entrances have accessibility ramps. The interior of the facility was observed to be sanitary and adequately furnished. The thermostat was set at 70 degrees for the comfort of the residents. LPA Jensen toured the kitchen and confirmed that a 2 day supply of perishable food and a 7 day supply of non-perishable food is maintained. There is a menu posted and the food being prepared for dinner accurately reflected what was posted on the menu. Cleaning supplies, toxins and knives were observed to be locked and inaccessible to residents in care. LPA Jensen observed 2 kitchen cabinets missing handles. Technical assistance was provided. LPA Jensen toured the resident bedrooms. The facility has 2 private bedrooms and 1 shared bedroom. The bedrooms were observed to contain all required furniture. Each bedroom was personalized to reflect the interests of the individual resident. The facility maintains an adequate supply of bedding and linens. LPA Jensen observed all required postings to be displayed in areas easily viewed by residents/staff and visitors. The facility maintains adequate supplies for activities to encourage resident engagement. The first aid kit was observed to be in compliance. LPA Jensen reviewed the emergency disaster plan and found it to be in compliance. The fire extinguisher was purchased on 8/29/23 and is in compliance. The smoke detector and carbon monoxide detector were determined to be in working order. The facility maintains 7 day supply of water in the event of an emergency. There is emergency lighting available. LPA Jensen toured the facility bathrooms. The master bedroom bathroom was observed to have a bucket underneath the sink with water in it and appears to be leaking. Technical assistance was provided. The temperature in the master bedroom bathroom was measured at 113 degrees which falls within the required range of 105 degrees to 120 degrees. There are night lights available in the hallways and bathrooms. The bathroom shower/tub areas have non-slip mats. There is an adequate supply hygiene products and towels available. The bathrooms have paper towel dispensers for infection control. LPA Jensen conducted a random medication audit and determined the record keeping to be accurate. A random audit of P&I funds was conducted and the accounting was determined to be accurate. LPA Jensen reviewed 3 of 3 staff files and found all staff files to be complete and in compliance. 4 of 4 resident records were reviewed and found to be complete and in compliance. The facility does not appear to have an updated Infection Control Plan submitted. Technical assistance was provided. Deficiencies are being cited from the California Code of Regulations (CCR) Title 22, Division 6. Failure to correct deficiencies may result in the assessment of civil penalties. An exit interview as conducted and a copy of this report and appeal rights were provided.