Routine inspection·January 7, 2025

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit at 09:40 A.M. LPA met with Licensee/Administrator, Margarita Colon. Entrance interview conducted. Beginning at 10:05 A.M., the LPA, along with Licensee/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: Fire extinguisher is fully charged and purchased on 01/01/2025. Smoke detectors were tested at 1:52 P.M. and functional at the time of the visit. At 1:54 P.M. two (2) Carbon Monoxide detectors were tested. During the inspection it was observed that both detectors were missing batteries and were non-functional. Staff replaced batteries in both detectors, and they were retested. Following the replacement, both carbon monoxide detectors were confirmed to be functional. No fire clearance concerns were observed. KITCHEN : The LPA observed the kitchen to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of seven (7) days non-perishable and two (2) days perishable food. Cleaning supplies and sharps are located in a locked cabinet under the kitchen sink. LPA conducted a review of expiration dates on product labels. At 10:30 A.M. hot water temperature was tested and measured at 124.5 degrees Fahrenheit. Continued on LIC 809-C Continued from LIC 809 COMMON AREAS : This includes the living room, family room, and dining room areas. LPA observed common area to be clean and properly furnished at the time of the visit. An adequately screened fireplace was noted in the living room. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. The facility maintained a comfortable temperature of 71 degrees. LPA observed a working phone available for residents use whenever needed. Facility provides sufficient space to accommodate indoor activities. BATHROOMS : There are two (2) bathrooms for resident use. Both are designated for shared resident use. Restrooms were observed to be equipped with slip resistant surfaces and contain slip resistant mats. Grab bars were observed in the bathrooms. LPA observed all bathrooms were clean, properly supplied and had functional fixtures. Residents have sufficient amounts of supplies for personal hygiene. At 10:48 A.M. hot water temperature was measured in one shared resident bathroom and measured at 118.2 degrees Fahrenheit. BEDROOMS : There are five (5) total bedrooms in the facility; 1 (one) is designated as a shared room and 4 (four) are designated as private resident rooms. Occupied rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There is an additional bedroom for staff use. GARAGE : Garage was observed locked and inaccessible to the residents in care. Garage contained laundry area, extra food, PPE and incontinence supplies, and emergency food and water. Continued on LIC 809-C Continued from LIC 809-C OUTDOOR SPACE: The backyard has a covered 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 at the time of the visit. Facility has a side gate which was observed to be self-closing and self-latching with clear passageways for emergency exit use. LPA observed cameras throughout the outside of the property only. Facility provides sufficient space to accommodate outdoor activities. LPA observed two (2) sheds containing holiday decorations, extra PPE and incontinence supplies, mobility devices and gardening tools. The property has two (2) homes with different house numbers/address. The homes are separated by a fence. RECORD REVIEW: Began at 11:00 A.M. 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. All 2 (two) resident files observed were in compliance with regulation. LPA reviewed three (3) staff files including Administrator’s. LPA observed Staff #1 (S1) and Staff #2 (S2) were missing proof of valid 1 st AID/CPR certification. During today’s visit S1 and S2 were able to renew 1 st AID/CPR certificate online. All other personnel files were reviewed and found to be complete, with no missing documentation or deficiencies noted. MEDICATION REVIEW: At 12:29 P.M. medications for 2 (two) residents were observed by the LPA. Medications are maintained locked in a hallway cabinet leading to the garage and they are inaccessible to residents. All medications observed were labeled and stored properly. However, discrepancies were identified in Resident’s 1 (R1) medication records during a medication count. The following was observed: Cyclobenzaprine 5 ML and Melatonin 3 MG were missing a dosage and Gabapentin 300 MG contained 3 extra capsules. Staff stated that R1 occasionally refuses to take medication. However, refusals were not documented in the centrally stored medication log nor the “end of date” staff notebook. Continued on LIC 809-C Continued from LIC 809-C LPA requested the following documents during today’s visit; Personnel Report (LIC 500), Handwritten Resident Roster, Liability Insurance. Emergency disaster drills are conducted quarterly, with the last drill conducted on 10/15/2024. Additionally, LPA observed emergency disaster plan to be complete and updated annually, as required. INTERVIEWS: During today's visit, LPA interviewed 1 (one) staff and 1 (one) resident. Pursuant to Title 22 CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D) and civil penalty issued. Exit interview conducted. Today's reports and appeal rights were discussed and copy was provided to Licensee.