Routine inspection·August 29, 2024

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced at 10:37AM to conduct an annual inspection. LPA initially met with facility staff. Administrator & Facility Designee were contacted via telephone. Designee Connie Roush arrived at 10:47AM, Administrator arrived at 11:10AM. Entrance interview conducted. At 10:52AM, 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 extinguishers throughout the facility were observed to be fully charged, but 2 (two) indicated were last serviced 10/08/2022; the third did not indicate a date purchased or date serviced. Facility management showed LPA there are new recently purchased extinguishers present in the facility garage, which will be exchanged for the ones inside. Hardwired smoke and carbon monoxide detectors and fire doors were tested at 02:35PM and were functional at the time of the visit. BEDROOMS : There are 8 (eight) bedrooms in the facility; the facility has 6 (six) private bedrooms for resident use, and 2 (two) staff rooms. Both staff rooms are kept locked. All resident rooms were observed to contain adequate lighting, proper furnishings and linens. BATHROOMS : The facility contains 4 (four) bathrooms; there are (2) two full bathrooms in the hallways. There are two (2) private bathrooms for resident use. The showers are equipped with nonskid surfaces and available nonskid mats. Grab bars were observed in the bathrooms. Hot water temperature in all resident bathrooms were well under the required range, measuring between 71.6 and 72 degrees Fahrenheit. In the hallway bathroom on the left, cleaning supplies were observed unlocked under the sink. In Continued on LIC 809-C Continued from LIC 809 the common bathroom on the right of the facility, air freshener was observed in the cabinet, accessible to residents in care. 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. The facility does have a fireplace, which was adequately screened. 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 living room wall. Hall closet contains extra linens and the door was off the track and falling down. KITCHEN : Kitchen knives are stored in a drawer on the left hand side of the stove, however at 11:04AM, the lock on the drawer was observed to be non-functional and knives were accessible to residents in care. The supply of perishable and nonperishable food is adequate. Appliances in the kitchen were clean and appeared functional. There is an adequate supply of emergency food. At 11:09AM, multiple dead bugs were observed throughout the kitchen area, as well as live bugs in the kitchen, dining room, and living room area. LAUNDRY /GARAGE : The laundry area is locked and located in the hallway to the right of the facility. Laundry detergent and chemicals are stored inaccessible in the laundry room. Entry to the garage is through the laundry room, so is also locked and inaccessible to residents in care. Garage contained extra food, storage, and additional items. EXTERIOR : The exterior passageways were obstructed with a barbecue and a recliner chair. Both were moved during the visit. 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. Exit gate on the side of the house was observed to be not self-latching at the time of the visit. FILES: Beginning at 11:40AM, LPA observed 6 (six) resident files for items including but not limited to physician's report, physician's orders, needs and service appraisals, and personal rights. Resident #1 (R1) was observed with full bed rails, but did not contain an order, nor is R1 on hospice. LPA observed 5 (five) Continued on LIC 809-C Continued from LIC 809-C staff files for items including but not limited to health screening, TB test, criminal record clearance, and training records. All staff files observed were maintained in compliance with regulation. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: The facility has an infection control plan, which was observed to be complete but not updated annually. Emergency disaster plan is also complete, but not updated annually. Emergency disaster drills are conducted, with the last drill documented on 01/08/2024. Regulation requires emergency drills documented quarterly. MEDICATIONS : Medications are in a locked closet at the entrance of the facility. The first aid supplies were complete, including a first aid manual. They were stored in the medication closet. At 01:43PM, medications for 2 (two) residents were observed. Start dates were either not listed or were not accurate on the Centrally Stored Medication and Destruction Record (CSMDR). For one resident (Resident #2 - R2) medications were written twice on the CSMDR with differing information including start date and prescription number. Medication count did not match the number of days elapsed from start dates indicated for either resident. 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). Exit interview was conducted. A copy of the report and Appeal Rights were reviewed and provided.