Routine inspection·March 21, 2024

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 09:14AM. LPA met with facility staff Marlene Santos. Entrance interview conducted. The Administrator was contacted, but was unavailable during today's visit. Facility staff is authorized to sign today's reports. Beginning at 09:44AM, the LPA, along with facility staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: Fire extinguishers are fully charged and serviced on 06/07/2023. Carbon Monoxide detector was tested at 12:10PM, smoke detectors were tested at 12:14PM and all were functional at the time of the visit. KITCHEN : The LPA observed the kitchen, which had visible debris and sticky substances inside the pantry, as well as dirt and grime around the appliances. Kitchen appliances appeared to be in operable condition. The facility did not have a sufficient supply of seven (7) days non-perishable food in all food groups. Staff indicated expired food was recently thrown away, so they have less food present today. Perishable food supply was observed to be sufficient. Cleaning supplies and sharps are located in separate locked cabinets. COMMON AREAS : This includes the living room and dining room areas. LPA observed common area to be clean and properly furnished at the time of the visit. Living room does contain an appropriately-screened fireplace. The LPA noted cameras in the common areas. BATHROOMS : There are two (2) bathrooms for resident use and one (1) for staff use. Resident restrooms were observed to be equipped with nonskid surfaces and contain nonskid mats. Grab bars were observed in the bathrooms. However, no paper products were supplied in either restroom. Staff indicated one resident does use too many paper products, so the supplies are not readily provided. The water temperature was Report Continued on LIC 809-C measured in one shared resident bathroom and measured within the required range. BEDROOMS : There are six (6) resident bedrooms designated for private resident use. There is also one staff room. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Alarms were observed on resident exit doors, however they were not in the "on" position and therefore not being utilized during today's visit. Additionally, R1's bed was observed to contain a full bed rail. R2's bed was observed to contain 2 half bed rails, effectively creating a full bed rail. OUTDOOR SPACE: The backyard has a patio area with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. There were no bodies of water on the premises. RECORD REVIEW: Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. 5 (five) resident files were observed. 3 (three) of 5 (five) resident files contained an appraisal which was more than 1 year old. 2 (two) of 5 (five) residents did not contain orders for the bed rails being utilized. 5 (five) staff files were observed. Administrator does not have proof of CPR and first aid, 2 (two) staff, both of which administer medications for residents did not contain proof of annual medication training. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan has not been updated since 02/20/2022. The last documented disaster drill was in 2021. Staff indicated none have been conducted in this current year. MEDICATION REVIEW: Medications for 2 (two) residents were observed. All medications observed were labeled, stored, and properly documented at the time of the visit. INTERVIEWS: During today's visit, LPA interviewed 2 (two) staff and 2 (two) residents. Pursuant to Title 22 CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Facility staff was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided. A copy of today's report was provided.