Routine inspection·September 19, 2024

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced at 09:49AM to conduct an annual inspection. LPA initially met with facility staff. Administrator & Facility Designee were contacted via telephone. Designee Connie Roush arrived at 10:00AM, Administrator arrived shortly thereafter. Entrance interview conducted. Beginning at 10:06AM, 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. The following was observed: Fire extinguisher was observed to be fully charged and purchased 01/19/2024. Hardwired combination smoke and carbon monoxide detectors and fire door were tested at 01:02PM. Fire door did not close properly during test. LPA advised that the fire door shall remain closed at all times until the latch is repaired. All other systems were functional at the time of the visit. KITCHEN : Kitchen knives are stored locked and inaccessible to residents in care. The supply of perishable and nonperishable food and emergency food and water supply is adequate. Appliances in the kitchen were clean and appeared functional. BEDROOMS : There are (6) six bedrooms in the facility; the facility has 6 (six) private bedrooms for resident use. Lighting in the rooms appeared adequate. All resident rooms contained the appropriate furnishings and linens. BATHROOMS : There are (2) two full bathrooms in the hallways. There are (1) private bathroom for resident use. The showers are equipped with nonskid surfaces and available nonskid mats. Grab bars were observed in the bathrooms. Hot water temperature measured at 139.4 degrees Fahrenheit at 10:14AM in the bathroom near bedroom #1. Hot water temperature measured at 135.3 degrees Fahrenheit at 10:23AM in the hallway bathroom. Hot water was not measured in the private resident restroom. Continued on LIC 809-C LAUNDRY/GARAGE : The laundry area is locked and located in the attached garage to the right of the facility. Laundry detergent and chemicals are stored inaccessible. EXTERIOR : The exterior passageways were clean and clear of any obstructions. There is a covered patio area in the backyard with tables and chairs for resident use. There are no bodies of water noted on the premises. The back and sides of the house are separated from the front yard by gates at the north and south side passageways the gate has a functioning self-latching mechanism for exit. COMMON AREAS: The common areas were appropriately furnished, and the lighting was adequate. There is a television and other entertainment equipment in the living room area. There is a functioning telephone on the premises. Emergency exiting plans/sketch are posted. Emergency telephone numbers are posted at the entrance area wall. Other required postings are also posted in the entrance area wall and dining room wall. FILES: Beginning at 10:35AM, LPA observed 4 (four) resident files for items including but not limited to physician's report, physician's orders, needs and service appraisals, and personal rights. All resident files were in order. LPA observed 4 (four) staff files for items including but not limited to health screening, TB test, criminal record clearance, and training records. Staff #1 (S1) was observed to be employed since April 2024 and did not have a valid fingerprint background clearance. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: The facility has an infection control plan and emergency disaster plan; both of which were observed to be complete and updated annually as required. Emergency disaster drills are conducted quarterly, with the last drill documented on 08/02/2024. MEDICATIONS : Medications are stored in a locked cabinet in the facility kitchen. The first aid supplies were complete, including a first aid manual. At 12:40PM, medications for 2 (two) residents were observed. Medications for both residents were observed to be properly stored and documented per regulation. INTERVIEWS: During today's visit, LPA conducted interviews with both staff and residents. No concerns were noted during interviews. Pursuant to Title 22, California Code of Regulations (CCR) and/or California Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D). Civil penalty issued in the amount of $500. Exit interview was conducted. A copy of the report and Appeal Rights were reviewed and provided.