Routine inspection·July 24, 2023

Licensing Program Analysts (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit at 08:15 a.m. When the LPA arrived, there was one staff and six residents present. The LPA was greeted by Caregiver Oscar Ortega and informed them of the reason for the visit. Administrator Mike Trejo shortly arrived. At approximately around 8:20 a.m. the LPA observed one of the residents (R5) agitated, walking in different directions within the home and stating, “I don’t know why I am here.” R5 appeared to be in distress and confused. Caregiver Ortega redirected R5 to sit down several times and telling R5, “Please sit down, so you don’t trip or hurt yourself.” At 8:25 a.m. the caregiver redirected R5 to sit down in a wheelchair and was going to place a restraining belt on R5 in the wheelchair. Upon observation, the LPA intervened and told the caregiver they cannot restrain residents. The Caregiver seemed confused, and asked the LPA, if they are not allowed to use the belt. The LPA had a conversation with the caregiver about following regulations and making sure residents are being well taken care of in a safe manner. The administrator arrived shortly after, and the LPA informed them of the incident and the administrator stated the caregiver should not have done that and that they will make sure all staff is trained on safely handling residents. The LPA advised the administrator they should contact R5’s physician and family. At 08:35am the LPA conducted a tour of the physical plant with Administrator Mike. The following was noted: Facility is a single-story residence that consists of four resident bedrooms and two bathrooms. The LPA observed (2) fire extinguishers last serviced in 2021. Upon observation, the administrator took both fire extinguishers to get serviced during the visit. All smoke alarms and carbon monoxide detector were tested and functioned properly during time of visit. The LPA observed all required postings throughout the facility. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. Report will continue on 809-C Kitchen : The kitchen appeared clean and the appliances and fixtures functional during the time of visit. At 8:44 a.m. The LPA observed an insufficient amount of perishable and non-perishable food at the facility for six residents. Upon observation, staff stated they had scheduled to go grocery shopping today, and wanted to make sure most items were finished before doing so. Staff showed the LPA a bag of grocery items they had brought to the home. Sharp objects are stored in a locked drawer, and cleaning chemicals are stored in a locked closet room. At 9:36 a.m. the LPA observed Clorox wipes in the kitchen. Upon observation the administrator stored them inaccessible to residents in care. At 2:00 p.m. staff showed the LPA all the fruit, meat and produce they had gone out and purchased during the visit. Staff also showed the LPA additional cabinets with non-perishable items and stated they had forgotten to show them during the tour due to being nervous. Bedrooms: The resident bedrooms were properly furnished with at least one chair, nightstand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. At 8:52 a.m. the LPA observed the following personal hygiene items in room#4: perineal cleanser, shampoo & body wash. Both residents in room#4 are diagnosed with dementia. One (R1) of the two residents in room#4 is at risk if allowed direct access to personal grooming and hygiene items. Bathrooms: LPA observed both bathrooms to be properly supplied and had functional fixtures. At 9:00 a.m. The LPA observed the outside bathroom without a slip mat and a pet shampoo on a shelf. Residents have sufficient amounts of supplies for personal hygiene. At 9:51 a.m. water measured 106.2 degrees Fahrenheit in one of the restrooms. At 9:16 a.m, the LPA observed a Ziploc bag full of disposable razors in the bathroom inside room#3. Upon observation, the administrator stored the pet shampoo and razors inaccessible to residents in care. Common Areas: These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. The facility maintained a comfortable temperature of 76 degrees. Garage: The garage is used as a storage and kept locked and inaccessible to residents in care. Report will continue on 809-C Surrounding Grounds (Outdoors) : There was a shaded area with proper furniture for outdoor use. The LPA observed a swimming pool properly gated, locked, and inaccessible to residents in care. The LPA observed all of the following in the back yard between 9:24 a.m. and 9:35 a.m. accessible to residents in care: three ladders, one hammer, one shovel, unlocked toolbox, fertilizer, a full container of bleach, one box of Aleve pills, and four prescription medication bottles (2 with Memantine tablets, and 2 with Simvastatin tablets). Upon observation the administrator locked all medication, and stated they will be cleaning the backyard and make sure all hazardous items to residents are locked and inaccessible to residents in care, due to five out of six residents diagnosed with Dementia. File review: A review of facility files was initiated at 9:45 a.m. and the following was observed. The LPA reviewed five (5) of six (6) resident Files. Out of the five files reviewed, the LPA identified that one resident (R3) is missing a physicians report, two residents (R1 & R2) need an updated annual physicians report, due to the diagnosis of dementia, two residents (R1 & R2 ) need an annual Appraisal & Needs and Service Plan report, due to the diagnosis of dementia, and one resident (R4) is missing TB information. The LPA reviewed four (4) out of five (5) staff files and the administrator’s file. Out of the four staff files reviewed, the LPA identified that four out of four staff are missing 3 hours of dementia annual training, 5 hours of annual medication training and 3 out of 4 hours of postural support and prohibited health training hours. The LPA also observed staff (S1) missing TB documents. Upon observation, S1 attempted to obtain TB documents from their physicians, and once they were unsuccessful, S1 went to emergency care to get TB tested and will not return to the home until results are given. I nterviews: During the visit the LPA conducted three (3) resident and three (3) staff interviews. No concerns voiced at this time. Due to time constraints the LPA will return to complete the annual at a later date. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Civil penalty was issued. Exit interview conducted and copy of the report and appeal rights provided