Routine inspection·January 9, 2024

At 10:05 a.m. Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit. The LPA was greeted by staff Alex Garcia and informed them of the reason for the visit. Licensee Adelaida Cruz arrived shortly. At 10:22 a.m. the LPA conducted a tour of the physical plant with the staff and Licensee to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The following was noted: Facility is a single-story residence that consists of two (2) living rooms, six (6) resident bedrooms, one (1) staff room, one (1) laundry room, two (2) communal restrooms and one (1) private resident restroom. The LPA observed fire extinguishers which were fully charged, however they were last serviced in October 2022. All smoke alarms and carbon monoxide detectors were tested and functioned properly. The LPA observed all required postings. Kitchen : During the facility tour at 10:22 a.m. the kitchen appeared clean and the appliances and fixtures functional. LPA observed sufficient amount of perishable and non-perishable food at the facility. Food is prepared based on the menu. Snacks and beverages are always available for the residents. Bedrooms: The resident bedrooms were properly furnished with at least one chair, nightstand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. At 10:37 a.m. the auditory alarm on the exit door to the backyard in room #5 was observed to not be working. During the tour the LPA observed hygiene/grooming items in rooms #2 ,#3, and #4, and all rooms in the facility were unlocked and open. The facility serves residents with dementia and residents who are at risk if allowed direct contact with grooming/hygiene items. At 10:40 a.m. the LPA observed Aquaphor healing ointment in room #4. At 10:46 a.m. the LPA observed, stained walls, stained bed sheets, two boxes of powdered Vitamin C, and a tube of athletes foot ointment in room #3. Report will continue on LIC809-C. Bathrooms: The LPA observed all bathrooms with functional fixtures, grab bars and non-skid mats. At 10:33 a.m. the LPA observed a bottle of Lysol toilet bowl cleaner in the communal resident bathroom, and observed the restroom to be unkempt with stains in the toilet, walls and upswept floor. At 10:50 a.m. the LPA observed the restroom inside room #3 unkempt with stains and residue in the shower floor, toilet and on the floor. At 11:24 a.m. water temperature in resident’s restroom was measured at 120 degrees Fahrenheit. Common Areas: These included the living rooms and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. There is a fireplace in both livings room, which were covered with a screen. The facility maintained a comfortable temperature of 70 degrees. There were no obstructions and/or tripping hazards throughout the facility. At 11:16 a.m. the LPA observed the living room screen door not properly installed , and observed the auditory alarm on the sliding glass door to not be properly working. The garage & Laundry room: The LPA observed the laundry room locked. The laundry room is connected to the garage and attic, which are both being used for storage. Cleaning supplies and disinfectants are kept in locked cabinets. Surrounding Grounds (Outdoors) : The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There are no bodies of water on the premises. Infection Control: The home has an adequate supply of Personal Protection Equipment (PPE) and can obtain additional supplies. Record Review: At 11:30 p.m. a review of facility files was initiated. The LPA reviewed five (5) out of six (6) resident files. The LPA identified that one out of five residents (R1) requires an updated physician’s report (LIC602), and an updated appraisal needs and service plan due to the diagnosis of dementia. Two (2) out of five (5) residents (R2,R3) require an updated appraisal/ needs and service plan LIC625. The LPA reviewed five (5) of five (5) staff files. One out of five staff (S1) did not have Tuberculosis test results on file. I nterviews: The LPA conducted two (2) resident Interviews. No immediate concerns were voiced. Due to time constraints the LPA will return to complete the annual at a later date. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report and appeal rights provided to Licensee.