Routine inspection·October 10, 2023

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced for a required one-year annual inspection today at 8:00 a.m. The last annual conducted at this facility was on 09/15/2022. When the LPA arrived, there were two (2) staff and three (3) residents present. The LPA was greeted at the door by Administrator, Bernadita Salvador and the reason for the visit was explained. Entrance interview conducted. At 8:10 a.m., the LPA along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: The LPA inspected the kitchen/food service area at 8:20 a.m. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The knives and sharps stored locked inside the pantry. The facility has a sufficient supply of perishable and non-perishable food. Food labels were inspected and checked for dates and expiration dates. At 8:22 a.m., the LPA observed non-perishable canned foods that were expired – fruit cocktail (qty – 3 expired 09/2022), peanut butter (qty-2 – expired 03/2021), canned vegetables (qty – 5 expired 05/2023), Campbells soup (qty – 3 expired 10/2022), bag of raisins (qty – 3 expired 10/2018), and packaged chicken breast (qty – 3 expired 10/2022). These items were discharged upon observation. (Report Continued on LIC 809C...) (Report Continued from LIC 809...) COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature. At 8:45 a.m., smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguishers were observed fully charged and last serviced on 3/15/2023. The LPA observed required postings throughout the common space. There is a washer and dryer by the hallway that is kept locked at all times when not in use. Cleaning supplies and detergents were observed locked and inaccessible time of the visit. The facility has at least a 30-day supply of Personal Protection Equipment (PPE). The facility has a working telephone on premises. The LPA observed working auditory alarms throughout the facility. BACKYARD: The facility has an adequate supply of emergency food and water. The backyard has a covered outdoor area equipped with furniture for resident use. Emergency exits and passageways were observed free of obstruction. There is one gate that self-latches. No bodies of water noted at the time of the visit. BEDROOMS: There are three (3) resident bedrooms. The LPA observed the resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. At 8:15 a.m., the LPA observed a bottle St. Ives lotion on top of the dresser inside bedroom #1. Item was locked immediately. There is a staff room on premises. The LPA observed a closet in the hallway with extra towels and linens. RESTROOMS: There is one (1) resident restroom. Restroom was clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared. The hot water temperature was measured at 111.7 degrees Fahrenheit at 8:16 a.m. (Report Continued on LIC 809C...) (Report Continued from LIC 809C...) RECORDS: Records review began at 8:51 a.m.; three (3) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. At 8:57 a.m., record review of Resident #1’s (R1’s) and Resident #2’s (R2’s) file review revealed that on R1’s Physician’s Report dated 06/12/2023 and R2’s Physician’s Report dated 05/26/2023 it states both R1 and R2 are at risk if allowed access to personal grooming and hygiene items. Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. The current Administrator’s file was also reviewed, and it was in order. The last emergency disaster drill was conducted on 09/30/2023. At 10:25 a.m., the LPA interviewed two (2) staff members. During today’s visit, the LPA obtained copies of the following: staff roster, resident roster, Emergency Disaster Plan, and a copy of the current liability insurance. MEDICATIONS: Medications review began at 10:45 a.m.; medications are centrally stored and locked in a cabinet by the main hallway. All medications including PRNs were labeled, stored, and locked i naccessible to residents. PRNs have physicians order on file. Medications are labeled and checked for expiration dates. No errors observed during the medication review. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.