Routine inspection (multi-day)·January 26, 2024

Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced Annual Continuation Visit to the facility to continue the annual inspection visit initiated on 12/21/2023. The LPA was greeted by MedTech Jennifer Diaz and informed them of the reason for the visit. Administrator Sean Beharry could not be present during the visit today and authorized MT Hazel Aspillaga to review and sign the report. Today the LPA conducted a medication audit, interviewed three staff, and finished the record review initiated on 12/21/2023. Interviews: During today’s visit, the LPA conducted three (3) staff interviews. Medications: At 1:45 p.m. a medications review was initiated for three out of five residents and the following was observed. The medications were stored in the medication room, which is locked and inaccessible to the residents. During Resident #3 (R#3's) audit, the LPA observed Donepezil HCL 5MG Tab still in the bubble pack, however the plastic bubble was punched out but medication not successfully poured out. MT Jennifer Diaz stated that when medication is not given it will be documented on the Medication Administration Record (MAR). However there was no documentation on R3’s MAR that the medication was not given. Record Review: The LPA observed documentation of Infection Control plan, Disaster prevention and Insurance liability. The LPA reviewed five (5) out of thirty-seven (37) resident files. The LPA was not able to review any of the five residents’ admissions agreements, due to them being stored in a separate file in the Administrators office. The administrator was not available for todays visit, and staff does not have access to the office. Out of the five files reviewed, the LPA identified that three files were missing the safeguards for property/valuables form, (SPV), two residents (R2,R5) did not have signed resident rights forms (LIC613), and three residents (R2, R3, R4) did not have their appraisal/needs and services form (LIC625) signed by the resident and/or their responsible party. 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.