Routine inspection·November 7, 2023

At 09:45 a.m. Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit. The LPA was greeted by Administrator Christina Ellivera and informed them of the reason for the visit. Licensee Christian Carino arrived shortly. At 10:17 a.m. the LPA conducted a tour of the physical plant with the Administrator and Licensee to ensure there are no health and safety hazards and 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, four (4) resident bedrooms, one (1) staff room, one (1) communal restroom and two (2) resident restrooms. The LPA observed one (1) fire extinguishers which was fully charged and last serviced 12/19/2022. All smoke alarms and carbon monoxide detectors were tested and functioned properly. The LPA observed all required postings in the hallway near the entrance area. Kitchen : During the facility tour at 10:26 a.m. the kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a 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. Bathrooms: The LPA observed all bathrooms, properly supplied and with functional fixtures. The LPA observed grab bars and non-skid mats in all bathrooms. At 10:34 a.m. water temperature in residents restroom was measured at 107.2 degrees Fahrenheit. The hot water measured was within the required limit of 105-120 degrees Fahrenheit. Report will continue on LIC809-C. 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 the first living room, which is covered with a screen. The facility maintained a comfortable temperature of 72 degrees. There were no obstructions and/or tripping hazards throughout the facility. The garage: At 10:24 a.m. the LPA observed the garage, where the washer and dryer are held, and the emergency food and water is stored. Cleaning supplies and disinfectants are kept in locked cabinets in the garage. The garage is not locked. 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. The home’s policies and procedures pertaining to infection control were adequate. Medications: At 10:44 a.m. a medications review was initiated. Medications are centrally stored and locked in a cabinet in the kitchen; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. The LPA observed all residents have PRN medications and the facility does not have PRN Authorization Letters on file to indicate whether the residents are able to make their own decision or if the doctor needs to be contacted prior to assisting the residents with the PRN medications. Record Review: At 11:23 p.m. a review of facility files was initiated. The LPA reviewed four (4) out of four (4) resident files. One out four residents (R1) did not have an admission agreement on file and one out of four residents (R2) did not have an appraisal/needs and services plan. The LPA reviewed five (5) of seven (7) staff files. Two out five staff (S1,S2) did not have a health screening with Tuberculosis results on file. Staff was observed to be missing dementia training. The LPA observed documentation of Infection Control, Disaster prevention and last fire drill (conducted on 10/15/2023). The LPA obtained a Client Roster and Staff Roster. I nterviews: At 02:20 p.m. the LPA conducted two (2) staff and one (1) resident Interviews. No immediate concerns were voiced. 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 Christian Carino.