Routine inspection·September 17, 2024

Licensing Program Analyst (LPA) Kristin Kontilis arrived at the facility unannounced to conduct a required annual visit at approximately 11:10 am. LPA met with Staff 1 (S1) and explained the purpose of the visit. Interim Administrator John Davis arrived at approximately 12:20 pm. Interim Administrator stated Administrator Lourdes Rickport has been out of the country since on or about September 8, 2024. LPA spoke with Administrator Rickport who stated she is due to return on or about October 1, 2024. Entrance interview conducted. At the time of arrival, there were two residents in care and two staff on duty. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for a capacity of six (6) non-ambulatory residents, one (1) of which can be bedridden. The facility has a hospice waiver for one (1) resident. Currently there are no residents on hospice, no bedridden residents, and no residents on oxygen. LPA Kontilis toured the facility inside and outside with Interim Administrator, John Davis. LPA noted the fire extinguisher was last serviced on 6/17/2024. The carbon monoxide detector and smoke alarms are properly working. The common areas, kitchen, and bedrooms are clean and in good condition. Bedrooms are properly furnished with nightstands, lamps, bed, and dressers. There are a total of five (5) bedrooms. Four (4) bedrooms are for resident use and one (1) bedroom is designated as a staff room. Bedroom 1 is a staff room. Bedrooms 2 and 4 are currently unoccupied. Resident 1 (R1) currently resides in Bedroom 3. Resident 2 (R2) currently resides in Bedroom 5. Bedroom 5 has a private bathroom. There are two bathrooms in the facility. Bathroom 1 is located off the hallway. Per Staff 1 (S1) and Staff 2 (S2), Bathroom 1 is primarily the staff bathroom and the private bathroom in Bedroom 5 is utilized to shower R1 and R2 at least once a week. Interim Administrator was unsure as to why the hallway bathroom is not used for residents in care. Please continue to 809-C, Pg 2. The backyard has an outdoor area with paved walkways, potted plants, trees and shrubs. LPA observed an excessive amount of debris and miscellaneous items such as but not limited to, equipment, metal bedframes, mattress, wheelchairs, commodes, hanger, and chairs. There were no bodies of water noted. An outdoor shed was observed to be locked and inaccessible to residents in care. LPA reviewed resident’s records for R1 and R2 including resident physician’s report and needs and service appraisals. LPA noted R2’s Physician’s Report is dated 4/21/2021. R2 was admitted into the facility on 7/4/2020. Staff records were reviewed for background clearance and to ensure all staff are properly associated to the facility. Record review revealed Interim Administrator has received a background clearance but has not been properly associated to the facility. The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.