Routine inspection·July 30, 2024

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 9:43AM. LPA met with Caregiver Lourdes Claro and Licensee/Administrator Marebeth Mallare who arrived at 10:05AM. Entrance interview conducted. Beginning at 9:44AM, the LPA, along with the Caregiver and 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 extinguishers are fully charged and were last serviced 01/14/2024. Hardwired smoke and carbon monoxide detectors were tested at 11:02AM and all were functional at the time of the visit. LPA observed exit alarms by all doors which were functional and operating. KITCHEN: LPA inspected the kitchen at 9:44AM. Knives and sharps are stored in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of 2 (two) days perishable and 7 (seven) days non-perishable food and an emergency water supply. Food was stored at appropriate temperatures. BEDROOMS : The facility consists of 6 (six) total bedrooms, 4 (four) are designated for resident use and 2 (two) are designated for staff use. Staff bedrooms were observed and were occupied by staff. 2 (two) out of 4 (four) resident rooms have exits to the exterior. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Report Continued on LIC 809-C LAUNDRY ROOM: LPA observed the locked laundry room adjacent to the kitchen. Laundry room has a washer and dryer and locked cleaning supplies. Staff rooms and staff bathroom are accessed through the laundry room. BATHROOMS : There are 4 (four) total bathrooms, of which 1 (one) is attached to resident room and 1 (one) is for staff use. Restrooms were observed to contain nonskid mats and grab bars by the showers and toilets. Water temperatures in all 3 (three) resident bathrooms were measured between 105.7 and 116.7 degrees Fahrenheit, which is within the required range. LPA observed storage space closets in hallway containing clean linens for resident use. COMMON AREAS : This includes the family room, TV room, and dining room. LPA observed common areas to be clean and properly furnished at the time of the visit. Facility is maintained at a comfortable temperature of 73 degrees Fahrenheit. LPA observed surveillance cameras in the common areas, however, they were not operating at the time of the visit. OUTDOOR SPACE: The backyard has a covered patio area with furniture including a table and chairs. There were no bodies of water on the premises. LPA observed a locked shed containing miscellaneous supplies. At 10:25AM, LPA observed the 2 (two) side exit doors outside to self-latch but failed to self-close. Only 1 (one) pathway is used as an emergency exit which was free of obstruction. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually as required. Emergency disaster drills are conducted quarterly as is required, with the last drill conducted on 06/01/2024. Report Continued on LIC 809-C RECORD REVIEW: LPA began record review at 10:31AM. LPA reviewed 5 (five) out of 5 (five) resident files and 4 (four) staff files 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. Resident files were complete and had no missing documents. At 10:08AM, LPA observed Staff #1 (S1) assisting Resident #1 (R1) with undergarments with the door open, failing to afford R1 privacy. LPA observed S1’s facility file to not contain trainings on residents’ rights. LPA and administrator discussed the importance of residents’ rights. At 12:10PM, LPA observed 1 (one) staff file to be missing 40 hours initial training records. LPA and administrator discussed training requirements. LPA explained how many hours per training topic is required and provided administrator with resources for initial and continuing trainings. MEDICATION REVIEW: Medications are centrally stored and locked in a cabinet in the dining room. LPA began medication review at 01:10PM and medications for 2 (two) residents were observed. 1 (one) out of 2 (two) resident medications observed were labeled and stored properly. At 1:20PM, LPA observed 4 (four) medications not logged properly on the centrally stored medication and destruction record. INTERVIEWS: During today's visit, LPAs interviewed 1 (one) staff and 2 (two) residents. During today's visit, LPA obtained a copy of the facility's liability insurance. The facility’s insurance expired 1 (one) day ago on 07/29, however, administrator has already submitted a renewal. Pursuant to Title 22, CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Civil penalty was issued in the amount of $500. Administrator was informed that failure to correct deficiencies may result in additional civil penalties. Exit interview conducted, report issued, and appeal rights provided.