Routine inspection·June 13, 2024

Licensing Program Analyst (LPA) Brian Balisi arrived at the facility unannounced to conduct a required annual visit. Upon arrival LPA met with staff and explained the reason for the visit. Administrator Walfre Alvizures arrived shortly after. The LPA 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. LPA began the inspection in the kitchen/food service area at 10:40 a.m. Knives are stored in a locked cabinet underneath the sink. Kitchen appliances observed to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food properly stored. Cleaning supplies were observed locked and inaccessible under the kitchen sink. At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature of 74 degrees Fahrenheit. Smoke detector(s) and carbon monoxide detector were operational at the time of the visit. The fire extinguishers were fully charged and were last serviced 03/11/2024. All exits have functioning auditory devices and were operational at the time of the visit. The LPA observed required postings throughout the common space. The backyard has a covered outdoor area equipped with furniture for resident use. The LPA observed one (1) self-latching gate with clear passageways clear of obstruction. There were no bodies of water noted. LPA observed two (2) sheds, both were observed to be inaccessible to residents in care. LPA observed both sheds to store extra furniture, medical equipment and other items for facility use. There is a separate laundry room that was observed inaccessible for residents at the time of the visit. The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are six (6) designated resident rooms. One wing of the home is designated as a private staff wing where staff reside. LPA observed it to be empty at this time.  The  resident restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in each restroom between 105 - 120 degrees Fahrenheit. Records review began at 11:30am. Five (5) resident records were reviewed for the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, appraisals, and current needs and services plan. At approx 11:30am, LPA observed Resident #1 (R1), Resident #2 (R2), Resident #3(R3), Resident #4(R4) and Resident #5 (R5), to have incomplete files. Missing documents are specified on 809-D. LPA reviewed staff files for, but not limited to, the following: personnel records, health screening, criminal record statements, and current first aid certification. At approx 12pm, LPA observed Staff #1 (S1) and Staff #2 (S2) to have criminal background clearance, but they were not associated to this facility. Administrator's file was missing the following - Education Verification, LIC 501, LIC 503, TB Test / Result, LIC 9052, SOC 341A .Last emergency disaster drill conducted last quarter. Administrator will conduct drill by end of month. Medications review began at 02:00 p.m. The medications are centrally stored and locked in a cabinet inside the kitchen. Medications are labeled and checked for expiration dates. No errors found during medication audit. INFECTION CONTROL: Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. At this time, the staff will continue to keep up signs that promotes good hand hygiene and symptoms of COVID. 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 an infectious disease. The facility’s policies and procedures as it pertains to infection control are adequate. Continued from 809-C LPA obtained the following documents at the time of visit: LIC500 Personnel Report, LIC9020 Client Roster, a copy of the emergency disaster plan, and a copy of the facility’s liability insurance. Staff and residents were interviewed during the visit. Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8, the following deficiencies were cited (refer to LIC 809-D). Civil Penalties assessed in the amount of $1,000. Failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.