Routine inspection·June 2, 2023

Licensing Program Analyst (LPA) Elsie Campos arrived at the facility unannounced to conduct a required annual visit at 9:30 a.m. The LPA met with Administrator Jennifer Shaffer and explained the reason for the visit. The LPA,and staff toured the physical plant areas at 9:45 a.m. inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. BEDROOMS: The LPA began the inspection in bedroom area at 9:45 a.m. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are four designated client rooms and one staff room. There was a linen closet in the hallway with extra towels and linens. The LPA observed accessible over the counter medications and prescription medications in a box in bedroom #4. RESTROOMS: The two client restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature measured in the hallway restroom at 118.2 degrees Fahrenheit. Accessible prescription mouthwash was observed by the LPA at 9:51 a.m. and unlocked cabinet in the hallway bathroom, cleaning supplies and hygiene items were observed to be unlocked under the kitchen sink. Accessible cleaning supplies were observed in bathroom inside bedroom #4. All accessible items were locked at the time of the visit. KITCHEN: Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable food and non-perishable food. At 10:05 a.m., the LPA and the Administrator observed expired grape juice dated 5/4/2023, exposed bag of powdered mash potatoes with unverifiable expiration date, exposed pancake mix with unverifiable expiration date, moldy broccoli in the refrigerator along with expired tomatoes, cabbage, exposed cut vegetables, open bag of frozen shrimp with freezer burn, open bag of frozen waffles with freezer burn, and exposed frozen meats with freezer burn. Continues on LIC 809C... The Administrator was advised to do a deep cleaning of the kitchen and conduct an audit of their food items. Staff cleaned refrigerator and disposed of expired items at the time of the visit. Centrally stored medication is kept in a kitchen cabinet which was observed to be unlocked at the time of the visit. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. Fire extinguisher was observed to be serviced on 4/10/2023 and fire alarm was tested at 10:28 a.m. and observed to be functioning at the time of the visit. The facility maintained a temperature of 73 degrees. All exits have functioning auditory devices. The LPA and the administrator observed the required postings in the common area. The backyard has a covered outdoor area equipped with furniture for resident use. The side gate door is self-latching however was observed to be in disrepair. Storage shack was observed to be unlocked as the door was in disrepair, storage shack contained gardening supplies and chemicals accessible to residents in care. There were no bodies of water noted. The garage is attached to the home which houses the laundry area. The garage was locked at the time of the visit. RECORDS: Residents’ records review began at 10:50 a.m., records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. 2 out of 5 records were in order. Resident #1 (R1), Resident #2 (R2) and Resident #3 (R3) were missing singed resident rights and signed consent forms additionally R1 was missing a needs and services plan. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 12:45 p.m., medications are centrally stored and kept in a locked cabinet in the kitchen which was observed to be unlocked at the time of the visit. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. 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. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. Continues on LIC 809C... The LPA obtained the following documents: LIC500 Personnel Report, LIC9020 Client Roster. 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 was conducted. A copy of the report and appeal rights were provided.