Routine inspection·September 24, 2021

Licensing Program Analyst (LPA) Ashley Smith arrived at the facility unannounced to conduct a required annual visit at 8:55 am. When the LPA arrived, there were two staff and four residents present. The LPA was greeted by staff and Administrator Maria Mendez and informed them of the reason for the visit. 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 9:05 a.m. Knives are stored in a locked drawer, yet the LPA observed two sharp knives in the sink at 9:08 a.m. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. The hot water temperature was initially measured in the kitchen at 103.4 degrees. The LPA had the Administrator adjust the water temperature. Yet the temperature measured no higher than 103.4 degrees during today’s visit. COMMON AREAS: Living room and dining furniture was observed to be in good condition. There is a fireplace in the living room, which is covered and inaccessible. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detector were operational at the time of the visit. The fire extinguishers were charged and were last serviced 6/1/2021. 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. There is a side gate for resident usage and is single latched. There were no bodies of water noted. The washer and dryer are held in the garage, including additional nonperishable and perishable food items. Cleaning supplies and disinfectants are kept in locked cabinets in the garage. The garage is not locked. BEDROOMS: R esident bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are four resident rooms, two which are shared and two private rooms. There is one staff room, which is kept locked. There was a linen closet in the hallway with extra towels and linens RESTROOMS: The two 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; towels and washcloths are not shared. The hot water temperature was measured in the common hallway restroom several times throughout the visit. The Administrator adjusted the water temperature several times, yet the temperature measured no higher than 103.1 degrees Fahrenheit. RECORDS: Resident records review began at 9:50 a.m.; resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. All records were in order. Personnel records reviews began at 10:35 a.m. and were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. The following was noted: one out of three staff (S1) requires three additional hours of medication training. One out of three staff (S2) needs a tuberculosis test and the first aid/CPR expired 6/2021. The Administrator’s Certificate expires 10/4/2021. The last disaster drill took place 7/2021. MEDICATIONS: Medications review began at 11:30 a.m.; medications are centrally stored and locked in a cabinet in the living room; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. Out of four records reviewed, R1 is only receiving 1000mg of Calcium but requires 1200mg a day, R2 needs a physician’s order for allergy medication (PRN), and R2 is only receiving 1000mg of Calcium but requires 2000mg a day. INFECTION CONTROL: Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. 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. The visitation protocol is adequate. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate. 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.