Routine inspection·September 30, 2024

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit at 10:15 A.M. LPA met with facility Administrator Erika Catabay and discussed the reason for today's visit. Entrance interview conducted. At 10:30 A.M., LPA, along with Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: Fire Extinguisher was observed to be fully charged and purchased on 08/29/2024. Hardwired combination smoke detectors and carbon monoxide detectors were tested at 12:52 P.M. and were functional at the time of the visit. COMMON SPACES: In the common areas, including dining room and living room, walls and flooring were checked for cleanliness and good condition. At the time of the visit, furniture was observed to be in good condition. The LPA observed the required postings in the common area. LPA observed the fireplace in the living room, which was adequately screened. Auditorial signal was observed in each door around the facility. Facility has a fire door to contain a fire from one side of the house to the other side. At the time and during LPA observed a stopped keeping fire door open. This stopper prevents fire door from closing and violates fire codes. KITCHEN : Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food, as well as emergency supply. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. At 11:27 A.M. hot water temperature measured at 117.9 degrees Fahrenheit. Cleaning compounds were stored under the kitchen sink and separately from food supplies. Continued on LIC 809-C Continued from LIC 809 BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, and sufficient lighting. There are 5 (five) total bedrooms; 4 (four) are for resident use. Two (2) shared rooms and 2 private rooms. Also, LPA observed a staff room. Staff room was observed locked. There is a bathroom adjacent to the staff room designated for staff only inaccessible to residents. BATHROOMS: The LPA observed 3 restrooms in the facility; 2 (two) are designated for resident use and one is a staff restroom. Resident restrooms are clean and sanitary with grab bars and non-skid surfaces. LPA observed that the toilet in the ladies’ bathroom was missing its lid. LPA observed men bathroom not to have a trash can with tight-fitting cover. Administrator replaced trash can immediately. Technical Advised was issued. Additionally, LPA observed both bathrooms without toilet paper. Administrator stated that dementia Resident #1 (R1), frequently enters both bathrooms and uses excessive amounts of toilet paper and paper towels, leading to unnecessary waste. As a result, toilet paper is not kept in the bathrooms to prevent this issue. Furthermore, LPA had a conversation with Administrator, during which LPA emphasized the importance of staff closely supervise R1 when in the bathroom to prevent waste or misuse of supplies. LPA explained that toilet paper and paper towels, shall be available for all residents and guests at all times to ensure proper care and accessibility. During LPA’s inspection, a sufficient supply of toilet paper was observed throughout the facility. Water temperatures were measured in all client bathrooms and measured within the required range of 105 degrees Fahrenheit to 120 degrees Fahrenheit at the time of the visit. OUTDOOR SPACE: The backyard area contains a shaded area with a table and chairs for resident use. There are 2 side gate doors with self-latching mechanisms. Passageways were observed to be clear and free of hazards. There were no bodies of water noted. Outdoor shed was observed locked. LAUNDRY ROOM/GARAGE: The washer and dryer were observed locked and inaccessible to residents. Cleaning supplies and disinfectants are kept in cabinets above the washer and dryer inaccessible to residents. Emergency food and Emergency water was observed in the locked garage. Continued on LIC 809-C Continued from LIC 809-C RECORD REVIEW: Began at 11:45 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. Six (6) resident records reviewed were missing consent form (LIC 627C). LPA had a conversation with Administrator. Technical Advise was issued. Administrator will provide proof of complete form for each resident. All other required forms were complete and up to date. Four (4) staff files reviewed, all containing necessary documents. MEDICATION REVIEW: Began at 2:30 P.M.; LPA reviewed medication log for all four (6) residents. Facility maintains a locked medication cart in the kitchen. Medications are labeled and checked for expiration dates. During medication audit, LPA discovered that Hospice Resident #2 (R2) was prescribed Zolpidem 5 MG once a day at bedtime on 09/25/2024. Staff member gave R2 medication on 09/25/2024, however from 9/26/2024 – 09/30/2025 prescribed medication was not administered. Also, Hospice Resident #3 (R3) had an order for Furosemide 20 MG. On the centrally stored medication and destruction record appears that medication was started on 09/09/2024. LPA checked bubble pack and from 09/09/2024 through 09/22/204 prescribed medication was given. After 09/22/2024 staff member stopped administering medication. Additionally, Hospice Resident #4 (R4), had a brand-new order for Lorazepam 0.5 MG to be started on October 1 st . Audit of medication reflects that bubble pack was opened and 3 pills from container were missing. Administrator stated that Hospice services are confusing staff members by giving them verbally direction on how to administer prescribed medication. LPA explained Administrator, that any changes should be in writing not verbally. . LPA obtained Client Roster, Staff Roster, and Liability insurance. Last emergency drill was conducted on 09/01/2024. A $500 immediate civil penalty is assessed today. The administrator was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) and 1569.49(f). Pursuant to Title 22 of the CA Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D):Exit interview conducted, appeal rights discussed, and a copy of this report issued.