Routine inspection·June 5, 2023

Licensing Program Analyst (LPA) Elsie Campos arrived at the facility unannounced to conduct a required annual visit at 10:30 a.m. The LPA met with Administrator Alma Flores and explained the reason for the visit. The LPA, and the Administrator toured the physical plant areas at 11:00 a.m. inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: The LPA began the inspection in the kitchen/food service area at 11:05 a.m. Knives and cleaning supplies are stored inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. BEDROOMS: Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are four designated client rooms. There was a linen closet in the hallway with extra towels and linens. RESTROOMS: The three 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 large hallway bathroom at 115.7 degrees Fahrenheit at 11:26 a.m. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature of 73 degrees. Smoke detector(s) and carbon monoxide detector were tested at 2:03 p.m. and operational at the time of the visit. The three (3) fire extinguishers were fully charged and were last serviced Feb 6, 2023. The LPA observed required postings throughout the common space. The Administrator was advised to post the Emergency Disaster Plan on the bulletin board. Continued on LIC 809-C OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for client use. There is a side gate for client use and is single latched. No bodies of water noted. The garage is attached to the facility, and this is where the washer and dryer are held, including additional refrigerator with perishable food items. Cleaning supplies and disinfectants are kept in locked in the garage. RECORDS: Residents’ records review began at 12:45 p.m., records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Staff files were incomplete and missing LIC 501 CCL Personnel Record and LIC 9052 Employee Rights for Staff #1, #2, #3, #4 and #5. LIC 508 Criminal Record Clearance was missing for Staff #1, #4 and #5. Additionally record review revealed that Staff #5 was not associated to the facility. Administrator completed association at the time of the visit. MEDICATIONS: Medications review began at 11:40 a.m.; medications are centrally stored and locked in a cabinet in the breakfast nook of the facility. 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. The LPA discussed the new PIN changes regarding infection control. The LPA obtained the following documents: LIC500 Personnel Report, LIC9020 Client Roster, Staff schedule. 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. Civil Penalty assessed in the amount of $500.