Routine inspection·July 30, 2024

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 09:14 AM. LPA was greeted by Facility staff who contacted the facility administrator Roxana Lara. Facility administrator arrived to the facility at approximately 09:20 AM Entrance interview conducted. Beginning at 09:22 AM, the LPA, along with facility administrator 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: 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. Cameras that do not record audio were observed in the common areas. A properly screened fireplace was noted in the living room. The LPA observed the fire extinguisher to be fully charged and purchased on 04/24/2024. Smoke detectors and carbon monoxide detectors were tested at 10:53 AM and were functional at the time of the visit. KITCHEN : The LPA observed the kitchen area to be clean. Kitchen appliances were in operable condition. The facility has a sufficient supply of seven (7) days perishable and two (2) days non-perishable food and emergency water. The LPA observed one designated cabinet where knives and sharps are stored locked and inaccessible to residents. GARAGE : The entry to the garage was observed to be locked and inaccessible to residents. The garage was observed to contain a washer and dryer, laundry supplies and chemicals are stored in in the garage along with various cleaning supplies. Garage contained adequate emergency food and water supplies. Report Continued on LIC 809-C Continued from LIC 809-C BATHROOMS : There are three (3) bathrooms for resident use. Bathrooms were observed to be equipped with nonskid surfaces and contain nonskid mats. Grab bars were observed next to all toilets and in all showers and all were properly secured. The water temperature was measured between 105.8 and 109.8 degrees Fahrenheit, which is in compliance with regulation. BEDROOMS : There are seven (7) bedrooms in the facility; six (6) are designated for resident use and one (1) is designated as a staff room. One (1) resident room was observed to lack a bed for the resident’s use. However, interviews with resident 1 (R1) confirmed that this was at their request and that they preferred to sleep in a recliner. All other resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. OUTDOOR SPACE: The backyard has sufficient patio furniture including shaded tables and chairs for resident use. One outdoor shed was observed to contain extra care supplies. Facility has two exit gates that were observed to fail to self-latch, LPA observed clear passageways for emergency exit use. RECORD REVIEW: At 10:26 AM 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. No deficiencies were observed during records review. MEDICATION REVIEW: Medications for 2 (two) of five (5) residents were observed. All medications reviewed were documented properly on their centrally stored medication and destruction record sheet and no deficiencies were observed during medication review. 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. Last emergency disaster drill was conducted 05/30/2024. The facility’s emergency disaster plan is up to date and adequate. Report Continued on LIC 809-C Continued from LIC 809-C INTERVIEWS: LPA interviewed two (2) staff and three (3) residents. All residents were happy with the food and activities offered. All residents stated that staff treat them well and are attentive to their needs. Both staff were knowledgeable on resident rights, the different forms of abuse, and their roles and responsibilities. During today’s visit LPA obtained a copy of the facility’s updated LIC500 and liability insurance. Due to a previous obligation administrator Roxana Lara had to leave the facility before a copy of the report was issued. Administrator has designated manager assistant Markdel Estrada to receive and sign the report in their absence. The following deficiencies were observed (See LIC 809-Ds) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Licensee was advised that failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.