Routine inspection·October 1, 2024

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 9:25AM. Upon arrival, LPA met with Administrator Holly Gold and explained the reason for the visit. Entrance interview conducted. Beginning at 09:32AM, the LPA, along with the 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: COMMON AREAS: The common areas include two (2) lounges, two (2) outdoor patios, dining room, activity room, beauty salon, and book nook. LPA observed required postings throughout the common area. Common areas were observed to be properly furnished with enough seating to accommodate residents and with appropriately screened fireplace. The facility maintained a comfortable temperature. LPA tested auditory exit device at 09:51AM, exits were observed to have functioning auditory devices and were operational at the time of the visit. Fire extinguishers throughout the facility were fully charged and were last serviced 04/09/2024. Fire system devices are tested annually and were last tested 06/06/2024. BEDROOMS: LPA inspected eleven (11) randomly selected bedrooms between 09:42AM – 11AM. Resident bedrooms were properly furnished with a bed, night stand, chest of drawers, closet space, and sufficient lighting for each resident. Bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. At 09:42AM, LPA observed stained carpets in room 1. At 09:51AM, LPA observed food crumbs and stains on the carpet in room 38. At 10:52AM, LPA observed a hole about 4 inches in size on the lower portion of the bathroom door, a broken dresser with a loose drawer that poses a safety hazard if it were to fall, and stained carpets in room 44. Administrator immediately replaced the broken dresser and will schedule a carpet shampooing. Report Continued on LIC 809 BATHROOMS: Resident bathrooms are shared between rooms with door access from each. Some bedrooms have private bathrooms that are not shared. LPA observed bathrooms in each resident bedroom to be clean and properly supplied with functional grab bars and fixtures. LPA observed pull cords by the toilet. Hot water was measured in five (5) bathrooms and was between 106.1 – 117.4 degrees Fahrenheit, which is within the required range. There are eight (8) shower rooms, however, four (4) are in use. Shower rooms were observed to be clean, sanitary, in operating condition with non-skid surfaces, and sufficiently stocked with linens and personal hygiene supplies. KITCHEN: At 10:21AM, LPA toured the kitchen. The kitchen is kept inaccessible to residents in care. Knives and sharps are kept inaccessible to residents in care. Kitchen appliances were observed to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 10:22AM, LPA observed a dented can of tomatoes, staff discarded can immediately, and observed enchilada sauce stored in an old cottage cheese container without dates or labels. Kitchen staff stated that the enchilada sauce was made one week ago. At 10:23AM, LPA observed two (2) containers of expired Lactaid Milk (expired 09/16/2024 and 09/29/2024). Staff immediately discarded expired items. At 10:28AM, LPA observed unlabeled and undated meats stored in the freezer that were gray in color and had freezer burn. Kitchen staff stated they will go through the freezer and remove all unlabeled and undated items. MEDICATION REVIEW: LPA began medication review at 10:29AM and reviewed medications for three (3) residents. Medications are centrally stored in the medication room by the business office. Medications are prepped up to 24 hours in advance in medication cups. All medications reviewed were stored and documented per regulation. RECORDS REVIEW: Beginning at 11:14AM, LPA reviewed five (5) personnel and five (5) residents files for documents including but not limited to: resident Admission Agreement, resident physician’s report, TB test, health screening, staff training and fingerprint clearance. All five (5) personnel and resident files reviewed were in compliance with regulation at the time of the visit. Report Continued on LIC 809 INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, LPA reviewed the facility's infection control policy as well as the emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually as required. Emergency disaster drills are conducted quarterly as is required, with the last drill conducted on 08/17/2024. INTERVIEWS: During today’s visit, LPA interviewed three (3) residents and three (3) staff. During today’s visit, LPA obtained a copy of the facility’s liability insurance. Pursuant to Title 22, CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Administrator was informed that failure to correct deficiencies may result in civil penalties. Exit interview conducted, report issued, and appeal rights provided.