Routine inspection·November 18, 2024

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit at 10:00 A.M. LPA met with Licensee/Administrator Estrella (Lillian) Alarcon. Entrance interview conducted. Beginning at 10:20 A.M., the LPA, along with Licensee/Administrator 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: Hardwired combination smoke and carbon monoxide detectors were tested at 11:00 A.M. and were functional at the time of the visit. Fire extinguishers was observed to be fully charged and purchased on 08/12/2024. BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 6 (six) total bedrooms for resident use and 1 (one) designated for staff use. RESTROOMS: The LPA observed 6 (six) restrooms in the facility. 5 (five) are for resident use and 1 (one) is designated for staff use only. Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. Between 10:35 A.M. and 10:45 A.M. hot water temperature was measured in all resident restrooms. Four (4) restrooms measured within the required range, however restroom next to room # 6, measured 131.3 degrees Fahrenheit. LPA did not check hot water temperature in the staff restroom. Continued on LIC 809-C COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common area. Two (2) fireplaces were observed to be adequately screened. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. The facility maintained a comfortable temperature of 73 degrees. Facility provides sufficient space to accommodate both indoor and outdoor activities. LPA observed a working phone available for residents use whenever needed. KITCHEN : Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. LPA conducted a review of expiration dates on product labels. At 10:48 A.M. hot water was measure at 128.4 degrees Fahrenheit. OUTDOOR SPACE: The backyard is shared between this facility and another related facility. The shared yard has a covered outdoor area equipped with furniture for resident use. The facility does have a fountain, but it was observed to be empty at the time of the visit. GARAGE/LAUNDRY ROOM: Adjacent to the staff room is a garage. LPA observed a washer and dryer. Garage remains locked. Garage contains cleaning, incontinence products, and PPE supplies as well as storage. Garage is shared with related facility. RECORD REVIEW: Between 11:15 A.M. and 12:35 P.M., Staff and resident records were reviewed 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. Six (6) resident records reviewed were complete and contained all required documents. Three (3) staff files reviewed were complete and contained all required documents. EMERGENCY DISASTER PLAN: Facility was evacuated on 11/06/2024 due to the “Mountain Fire”. During today’s visit, the LPA reviewed the facility’s infection control plan. The facility’s policies and procedures as it pertains to emergency disaster plan are adequate, complete, and updated annually, as required. Emergency drills are conducted monthly, with the last drill documented on 11/02/2024. Continued from LIC 809 Continued from LIC 809-C INTERVIEWS: Throughout the visit, LPA interviewed 2 (two) staff and 1 (one) resident. MEDICATION REVIEW: At 1:15 P.M. medications for six (6) residents were observed. All residents' prescription medications were observed to be maintained and administered in compliance with regulation. During today's visit, LPA gathered the following items: Personnel Records (LIC 500), Current certificate of insurance, Resident Rooster (LIC 9020). Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.