Routine inspection·April 12, 2023

Licensing Program Analysts (LPAs) Kelly Dulek and Emily Peraldi arrived at the facility unannounced to conduct a required annual visit at 09:13AM. LPAs were greeted by facility staff and initially met with Esmeralda Elizarraraz and explained the reason for today’s visit. Administrator Monica Reyes arrived shortly thereafter. Entrance interview conducted. Beginning at 09:44AM, the LPAs, along with the 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: BEDROOMS: The facility consists of 107 total bedrooms, of which LPAs observed 10 resident bedrooms; 2 in the Meadows (Memory Care) and 8 in Assisted Living. All resident rooms observed were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. At 09:52AM, in Resident #1 (R1)’s room LPAs observed the following: Mucus DM Extended Release, Vicks VapoRub, Beta Prostate Max, Calmoseptine, A&D Ointment, Remedy Phytoplex Clear-Aid Ointment and other various medications. RESTROOMS : Each resident room contains its own private restroom. Resident restrooms observed contained sufficient grab bars and non-skid surfaces. At 10:02AM, in Room 415, water temperature measured at 126.7 degrees Fahrenheit. At 10:08AM, in Room 403, water temperature measured at 124.1 degrees Fahrenheit. COMMON AREAS : Consisting of the lobby, library, activity room, dining room, bistro, and movie room in the Assisted Living side and activity room and dining room in the Meadows side. The LPAs observed common areas to be relatively clean and properly furnished at the time of the visit. The LPAs observed the fire extinguishers to be fully charged and last serviced on 02/08/2023. All hardwired smoke alarms as well as Continued on LIC 809-C fire doors and sprinkler system were inspected during the fire inspection which took place on 05/18/2022 and were functional at that time. During today’s visit, at 04:36PM, carbon monoxide detectors were tested and functioned properly. The temperature was maintained at a comfortable level throughout the building. Cleaning supplies and disinfectants are stored locked per regulation. The LPAs observed cameras in the common areas. A working telephone is present. The LPAs observed the required postings in the common area. OUTDOOR SPACE: At 10:37AM, the LPAs observed the building and grounds in both Assisted Living and Memory Care. Multiple seating areas were observed with tables and chairs and shaded seating areas for resident use. RECORD REVIEW: Began at 11:12AM, LPAs reviewed staff and resident records for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisals, and admission agreements. 5 of 5 staff files reviewed contained all documents, except documentation of required initial and annual training. Administrator indicated staff have completed all required training but was unable to access the records due to the internet not functioning at this time. 5 resident files were reviewed. 2 of 5 resident files reviewed did not contain a current reappraisal, however current appraisals were completed during today’s visit. Remaining files reviewed were observed to be in compliance. MEDICATION REVIEW: Began at 01:28PM. Medications for 5 residents were reviewed. At 01:30PM, Resident #2 (R2)’s medication Multaq 400mg was observed. PM dose was not initialed as administered on the April Medication Administration Record (MAR) at all, however 11 pills were not remaining in the bubble pack and bubble pack was started on 04/01/2023. At 01:39PM, Resident #3 (R3)’s medication Vitamin B-12 100mg, which is ordered weekly on Mondays. Start date is indicated as 04/01/2023 and the package originally contained 5 pills. 2 pills remain in the bubble pack, however only 2 Mondays have passed in April. At 01:49PM, LPAs observed Resident #4 (R4)’s medication Hydrocodone APAP 10-325. Bubble pack originally contained 30 doses of 2 pills each. 12 doses remain in the bubble pack and the start date is listed as 04/09/2023. MAR reviewed indicated 14 doses have been administered since 04/09/2023, leaving 4 doses of 2 pills each unaccounted for. At 01:51PM, R4’s Metformin HCL 1000mg was observed. 2 bubble packs Report Continued on LIC 809-C originally contained 60 doses. Each bubble pack has 18 remaining doses, however MAR indicates 23 doses have been administered, leaving one dose unaccounted for. At 02:09PM, R1’s pm medication Melatonin 5mg was observed, which originally contained 30 doses, start date is listed as 03/23/2023. 20 days have elapsed since the listed start date. Therefore, 10 doses should remain, however LPAs observed 8 remaining doses in the bubble pack. KITCHEN: At 03:32PM, LPA Dulek observed the kitchen/dining area. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food, including emergency supply. At 03:34PM, LPA observed 12 cans of Annie’s Cheesy Ravioli with a best by date of 09/04/2022. At 03:35PM, LPA observed 4 cans of Hunts Tomato Paste with a best by date of 02/27/2023. At 03:35PM, LPA observed 4 cans of Siniora Chicken Luncheon Meat with a sell by date of 02/25/2021. At 03:37PM, LPA observed 3 cans of condensed milk with a best by date of 10/22/2022. At 03:42PM, LPA observed 2 packages of tofu in the refrigerator with a use by date of 03/30/2023. INFECTION CONTROL: During today’s visit, the LPAs spoke with the Administrator regarding the facility’s infection control practices. The facility’s policies and procedures as it pertains to infection control are adequate. INTERVIEWS: Throughout today’s visit, LPAs interviewed 4 (four) staff and 4 (four) residents. The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.