Routine inspection·July 6, 2023

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct a required annual visit. The last annual conducted at this facility was on 07/06/2022. Upon arrival, the LPA was greeted at the door by staff. The Administrator, Norma Zanders arrived shortly after and the reason for the visit was explained. Entrance interview conducted. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. KITCHEN: The LPA inspected the kitchen/food service area at 9:30 a.m. The LPA observed two residents having breakfast at the dining table. Knives are stored in a locked cabinet in the kitchen. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 9:35 a.m., the hot water temperature was measured in the kitchen at 113.7 degrees Fahrenheit. Cleaning supplies were observed locked and inaccessible under the kitchen sink. COMMON AREAS: At the time of the visit, the living room furniture was observed to be in good condition. The facility maintained a comfortable temperature of 72 degrees Fahrenheit. Smoke detector(s) and carbon monoxide detector were operational at the time of the visit. At 9:45 a.m., the fire extinguisher was observed to be last charged on 09/14/2021. Administrator stated they were waiting on the service technician to recharge. All exits have functioning auditory devices and were operational at the time of the visit. The LPA observed required postings throughout the common space. The backyard has a covered outdoor area equipped with furniture including a table and chairs for resident use. The LPA observed one (1) self-latching gate with clear passageways clear of obstruction. There were no bodies of water noted at the time of the visit. Report Continued on LIC 809C... Report Continued from LIC C809... The laundry room is located in the garage, which is kept locked at all times. Cleaning supplies and disinfectants are also kept locked inside the garage. Emergency water and food was observed in good condition at the time of the visit. The last fire drill was conducted in March 2023. BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are four (4) designated resident rooms. Two (2) bedrooms are private, and two (2) bedrooms are shared. The facility has staff bedrooms and sections upstairs in the second floor which is maintained inaccessible to residents at all times. RESTROOMS: The two (2) resident restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured; the first bathroom measured at 113.5 degrees Fahrenheit at 9:40 a.m.; and the second bathroom measured at 113.9 degrees Fahrenheit at 9:42 a.m. RECORDS: Records review began at 9:58 a.m.; six (6) resident records were reviewed for the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, appraisals, and current needs and services plan. Resident #1’s (R1’s) LIC 602A indicated R1 has no capacity for self-care and is not on hospice. Administrator stated R1 was no longer on hospice and was able to do certain activities of daily living (ADL’s) on their own. R1’s Primary Care Physician (PCP) faxed an updated LIC 602A indicating R1 has capacity for self-care during the time of visit. All resident files are now in order. The LPA reviewed four (4) staff files for, but not limited to, the following: personnel records, health screening, criminal record statements, and current first aid certification. All files and training is in order. The LPA also audited the current Administrator’s file, and it was in order. The LPA obtained the following documents at the time of visit: LIC500 Personnel Report, LIC9020 Client Roster, a copy of the emergency disaster plan, and a copy of the facility’s liability insurance. Report Continued on LIC 809C... Report Continued from LIC 809C... MEDICATIONS: Medications review began at 1:20 p.m. The medications are centrally stored and locked in a cabinet adjacent to the kitchen. Medications are labeled and checked for expiration dates. No errors found during medication audit. INFECTION CONTROL: Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. At this time, the staff will continue to keep up signs that promotes good hand hygiene and symptoms of COVID - 19. The facility has an adequate supply of Personal Protection Equipment (PPE), and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of an infectious disease. The facility’s policies and procedures as it pertains to infection control are adequate. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Exit interview conducted. A copy of the report and appeal rights was provided to the Administrator.