Routine inspection·March 27, 2024

Unannounced annual visit made out to this facility on 03/27/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Jerry Caparros, who was briefly interviewed. It was learned that there were (4) residents under the care of hospice at this time. It was learned that there were other residents who were receiving services through home health as well. This facility does have a hospice waiver approved for (4) residents since 2020. This facility also has, on file, a program to accept and retain residents diagnosed with dementia at this time. Current census was 6 residents. A tour of this facility was conducted. Administrator certificate was observed to be present and in compliance at this time for facility designated Administrator Jerry Caparros. Forms and documents were submitted to renew for Certificate #6005959740 that is set to expire on 07/27/2025. Kitchen area was toured. Cabinets and drawers were reviewed. Food preparation stations, dishwashing station, and other areas intended for meal preps were toured. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. This LPA did observe additional food storage units which were present and functional at this time. A tour of the dining area, living area, and all other areas intended for resident use was conducted. Medication cabinet, located in hallway closet, was reviewed. Policies and procedures involving dispensing, documenting, and overall administration of resident medications were discussed with the facility designated Administrator at this time. The medication cabinet was observed to be locked and made inaccessible to the residents at this time. A tour of the resident bedrooms and restrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees. Linen closet, located in the facility laundry area, was observed to contain a sufficient supply of towels, blankets, and linens to meet the needs of the residents at this time. Fire extinguishers, located throughout this facility, were observed to have been annually inspected on 01/15/2024 by the local fire extinguisher company, Assured Fire Extinguisher Services, and in compliance at this time. First aid kit was observed to be present and contained all of the required components at this time. Exterior grounds of this facility were toured. A review of the facility perimeter fence, side gates, and exits was conducted. A review of (5) facility resident files was conducted and noted on the following LIC 858. A review of (5) facility personnel files was conducted and noted on the following LIC 859. The following forms and documents were requested to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal Rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interview