Routine inspection (multi-day)·December 6, 2021

Licensing Program Analyst (LPA) JoAnn Rosales conducted an unannounced Case Management - Annual Continuation visit. LPA met with Administrator Evan Granucci. *This is an amended report to make corrections noted after further review of the report*. A physical plant tour was conducted to ensure there are no health and safety hazards. During facility tour at 11:11 am with Administrator LPA observed a housekeeping cart outside of room #208 with cleaner and degreaser and bleach germicidal cleaner accessible to residents. Administrator located housekeeping staff #1 (S1) in a resident laundry room down the hall. During facility tour at 11:21 am with Administrator LPA observed a housekeeping cart outside of room #638 with stainless steel cleaner, toilet cleaner, comet and cleaner and degreaser accessible to residents. Administrator located housekeeping staff S2 in room #638. During facility tour at 11:32 am with Administrator LPA observed a housekeeping cart outside of room #53 with furniture polish, stainless steel cleaner, toilet cleaner, comet, glass cleaner, floor cleaner and bleach germicidal cleaner accessible to residents. Administrator located housekeeping staff S3 inside room #53. Administrator stated that the housekeeping staff normally take the chemicals with them inside the resident rooms while they are cleaning. LPA reviewed random resident medications. During a review of resident medications at 12:11 pm with S4 LPA observed that resident #1 (R1) is prescribed gabapentin 300 mg 1 capsule by mouth at bedtime. R1 was not given the medication on 12/3/21 as it was still in the bubblepack. The admin history for R1's medication indicates that R1 was given their medication on 12/3/21 at 8:38 pm. LPA observed first aid kit complete. LPA reviewed random staff records. Due to computer issues LPA is unable to amend the 10/21/21 Required 1-year visit report citation 87465(h)(2) Incidental Medical and Dental Care Services . The citation of 87465(h)(2) is being amended to 87705(f)(2) Care of Persons with Dementia and is being cited on this Case Management visit report. Continued on 809C Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Civil penalties issues in the amount of $250.00. Exit interview conducted. Today's reports, civil penalty and appeal rights were reviewed and emailed to the Administrator.