Routine inspection·February 21, 2024

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual inspection. The LPA was greeted by staff and informed them of the reason for the visit. Facility designated staff Melissa Briones arrived shortly thereafter. The LPA and the staff 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. KITCHEN: Knives and cleaning supplies are stored locked and inaccessible to residents. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable foods, and seven-day supply of non-perishable food. The fire extinguisher was purchased on 02/21/2024. BEDROOMS: Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There was a linen closet in the hallway with extra towels and linens. BATHROOMS: Bathrooms 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. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. The facility maintained a comfortable temperature of 76 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The LPA observed required postings throughout the common space. The washer and dryer are located next to the medication closet. The laundry room is inaccessible to residents in care. OUTDOOR AREA/GARAGE: 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 property and is locked and inaccessible to residents. Cleaning supplies and disinfectants are kept locked in the garage. Continues on LIC809C... RECORDS: Records review began at 1:55 p.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. Four (4) out of six files were missing the Identification and Emergency Contact form (LIC601). Five (5) out of six files were missing the Resident Appraisal (LIC603A) form. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Six (6) out of six files were missing the Health Screening Form (LIC 503), and one(1) out of six files was missing the Personnel/Employment form (LIC 501). MEDICATIONS: Medications review began at 3:37 p.m. Medications are centrally stored and locked in a closet next to the laundry room; medications are labeled and were checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record form. No errors observed during the medication review. INFECTION CONTROL : 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 reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster Deficiencies cited at this time. Exit interview conducted. A copy of the report and Appeal Rights were issued.