Routine inspection·June 4, 2024

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit. Upon arrival, there were two staff and four residents present. The Assistant Administrator Karina Antig was contacted over the phone and arrived shortly after the visit began. Entrance interview conducted. At 11:15AM, the LPA, along with Assistant 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. The following was observed: LPA noted the facility to be under construction currently. Notification was sent to the Regional Office (RO) on 05/14/2024 indicating 1 bathroom would be renovated and kitchen flooring replaced. Notification also indicated no major construction required and that the scheduled time frame was 05/13/2024 to 05/25/2024. No extension or change of scope of work was received at the RO as of today's date. LPA discussed with Assistant Administrator sending an updated notification letter, as well as ensuring all required building permits are obtained. BEDROOMS: Typically, there are 4 (four) designated resident rooms and 1 (one) staff room inside the locked garage area, as well as an upstairs area solely dedicated to staff use. At this time, 3 (three) resident rooms are being utilized for resident sleeping use and a vacant resident room is being utilized as a shared common space. LPA observed the 3 (three) resident rooms to contain appropriate linens and furnishings. However, exit doors in all 3 (three) rooms were blocked with storage items, and at least 1 (one) of the doors was observed to be dead bolted shut at the time of the visit. RESTROOMS: The facility contains 2 (two) shared resident restrooms and 1 (one) staff restroom upstairs. The bathrooms were sufficiently stocked with supplies and paper towels. 1 (one) resident restroom was locked and under construction. The hot water temperature was measured in the common hallway restroom at 129.4 degrees Fahrenheit at 11:28AM. Report Continued on LIC 809-C KITCHEN: The kitchen area was observed to be covered in plastic and currently under construction. All appliances have been removed and/or relocated. Beginning at 11:43AM, LPA observed the facility refrigerator to be in the dining room, and containing multiple expired foods, including but not limited to: 4 18-packs of eggs with a use by date of 05/24/2024, Best Foods Mayonnaise with a best before date of 03/10/2024, Tree Top Applesauce with a best buy date of 07/25/2023, grapes and vegetable medley that were observed browned. Additionally, LPA noted multiple plastic storage containers containing leftover foods, which were not labeled nor dated. Assistant Administrator stated that due to the kitchen construction, they are currently utilizing an off-site kitchen to prepare dinner. Lunch and breakfast are prepared by staff either in the facility side yard or in the dining room using small kitchen appliances only. COMMON AREAS: Due to the construction, the living room and dining room are being used as storage areas. The common living room has been relocated to a vacant resident room. 2 (two) fire extinguishers were observed to be fully charged and last serviced 05/14/2024. Front door exit contains a latch at the bottom, and all other remaining common area exits were observed to be blocked and/or locked at the time of the visit. The LPA observed required postings throughout the common space. GARAGE AND GROUNDS : The garage is attached to the house and locked at all times. The laundry room is in the garage locked and inaccessible. Cleaning supplies and disinfectants are kept in locked cabinets in the garage. There is one (1) additional refrigerator and one (1) freezer in the garage with perishable items. Facility has an adequate amount of emergency food and emergency water. Outdoor area was observed to be used as storage and preparation for the construction, so was unable to be properly assessed for compliance. Passageway to the exit gate was observed to be blocked by a table containing small kitchen appliances. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: Not reviewed during today's visit. RECORDS/MEDICATIONS: LPA reviewed 2 (two) resident files during today's visit. LPA observed both residents to be on hospice, however the facility's approved hospice waiver is for 1 (one) hospice resident. Remaining files will be reviewed during the annual continuation visit. Medications were observed to be stored locked; medications were not reviewed today. 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. A $500 civil penalty was assessed. Failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted. A copy of today's report and appeal rights were provided.