Report Continued on LIC 809C PAGE 2.....

KITCHEN: The LPA inspected the kitchen/food service area at 10:20 a.m. Knives and sharps were observed in a locked cabinet. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 106.0 degrees Fahrenheit at 10:21 a.m. Cleaning solutions, toxins, chemicals, and hazardous items were inaccessible and locked away inside a kitchen cabinet under the sink.

BEDROOMS: The facility is a single-story residential home with six (6) bedrooms, five (5) for resident use and one (1) for staff use. Staff room remains locked at all times. Currently all five (5) resident bedroom are private, single occupancy. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Inside temperature was maintained at a comfortable level.

BATHROOMS: The facility has a total of three (3) bathrooms. Two (2) are resident bathrooms of which one (1) is a shared resident use, one (1) is a private resident use, and one (1) for staff use. Restrooms were clean and sanitary and in operating condition with grab bars and non-skid mats. Hot water was measured in resident bathrooms. The shared bathroom measured at 118.6-degree Fahrenheit at 10:14 a.m. and the private bathroom at 120.0-degree Fahrenheit at 10:18 a.m. both within the required range. The sinks had sufficient liquid soap, and paper towels.

OUTDOOR SPACE/ GARAGE: The LPA observed the back yard which had a shaded patio area with patio furniture including a table and chairs for resident use. The LPA observed one gate that self-latches with a clear passageway in case of an emergency. There are no bodies of water on the premises at the time of the visit. The garage is not accessible to residents. Laundry units, cleaning solutions, toxins, chemicals, and hazardous items are kept in the locked laundry room attached in the backyard. There is a garage that is kept locked and inaccessible to residents at all times.

Report Continued on LIC 809C PAGE 3......

INTERVIEWS: One (1) staff interview was conducted. Two (2) resident interviews were conducted at the time of the visit from 10:00 a.m. – 10:20 a.m.

MEDICATIONS: Medications review began at approximately 12:45 p.m. Medications are centrally stored and locked in a kitchen cabinet; medications are labeled and were checked for expiration dates. During the medication review the LPA and the licensee observed that the medications were not properly documented on the centrally stored medications and destruction record. The following errors were observed during the medication review. One (1) out of five (5) residents’ Centrally Stored Medication and Destruction Record form was incorrectly filled out. Resident #1 (R1) forms had the incorrect date of when the prescription was started, missing and incorrect quantity of pills. Medication (Senna 8.6 mg /60 pills/ date filled: 10/18/2024 / date started: 11/1/2024) was not documented correctly as 23 days have been popped and there have only been 21 days in the month. Two (2) days are unaccounted for which poses an immediate health, safety or personal rights risk to persons in care.

Documents obtained during the visit include: LIC 500 facility roster, LIC 9020A Resident roster, and current Liability Insurance.

The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. The Licensee was made aware that failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.