Routine inspection·June 15, 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 06/16/2022. Upon arrival, the LPA met with Administrator, Marilou Mallari 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 facility is in compliance with Title 22 Regulations. KITCHEN: The LPA began the inspection in the kitchen/food service area at 11:30 a.m. 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 11:38 a.m., the LPA observed perishable items in poor condition – ranch (expired 05/2023) and two canned good (expired 12/2022 and 03/2023). These items were discarded upon observation. At 11:34 a.m., the hot water temperature was measured in the kitchen at 109.4 degrees Fahrenheit. Cleaning supplies were observed locked and inaccessible under the kitchen sink. 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 of 74 degrees Fahrenheit. Smoke detector(s) and carbon monoxide detector were operational at the time of the visit. The fire extinguishers were fully charged and were last serviced 09/2022. 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 for resident use. The LPA observed one (1) self-latching gate with clear passageways clear of obstruction. There were no bodies of water noted. There is a separate laundry room, which is kept locked at all times. Cleaning supplies and disinfectants are kept locked inside the laundry room. Emergency water was observed in a closet by the entrance. Report Continued on LIC 809C... Report Continued from LIC C809... 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. The facility has one (1) designated staff bedroom that is maintained locked at all times. RESTROOMS: The three 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 11:21 a.m.; the second bathroom measured at 108.4 degrees Fahrenheit at 11:25 a.m.; and the third bathroom measured at 113.00 degrees Fahrenheit at 11:25 a.m. RECORDS: Records review began at 11:45 a.m.; five (5) 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. All records were in order. The LPA reviewed two (2) staff files for, but not limited to, the following: personnel records, health screening, criminal record statements, and current first aid certification. Although the facility had a designate training binder, the LPA was unable to determine the number of hours completed per regulation for the past 12 months. The LPA also audited the current Administrator’s file, and it was in order. (Administrative Certification Training and renewal documents have been sent to Sacramento). 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. MEDICATIONS: Medications review began at 1:15 p.m. The medications are centrally stored and locked in a cabinet inside the kitchen. Medications are labeled and checked for expiration dates. At 1:17 p.m., the LPA observed Resident #1 (R1) medication to have dates written on the bottles. The Administrator removed the writing at the time of the visit. No errors found during medication audit. Report COntinued on LIC 809C... Report Continued from LIC 809C... 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. 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. Exit interview conducted. A copy of the report was provided to the Administrator.