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32 | Kitchen appliances were observed operational. The home has sufficient 2-day perishable and 7-day non-perishable food supply. LPA inspected the inside of the kitchen cabinets and observed roach droppings and food particles like grease and crumbs on the shelves above and below the sink. LPA also observed live and dead roaches on the kitchen counter by the sink in the top and bottom kitchen cabinets inside the shelf area. Also observed were several roach traps underneath the kitchen sink and on the counter by the kitchen faucet. Two resident insulin pens and lancets were observed in a Zip-Loc bag on the refrigerator door shelf.
The front and backyard are kept clean, and a shaded patio area is available for residents. Garden is well maintained and there are no pools or other bodies of water. The garage is kept free of clutter and kept locked. Overflow refrigerator was observed in the garage and was working properly. The home is equipped with one fire extinguisher and was observed charged and operational. The facility has an emergency disaster plan in place and safety drills are conducted monthly. Last drill was conducted on 6/3/2026. Emergency supplies and extra incontinence care items are kept stored in the garage and are readily available for use.
Five (5) staff files were reviewed. According to record review and staff interview, S4 and S5 do not have a Health Screening/TB clearance. Administrator indicated that S4 was hired on 6/15/2026 and S5 was hired on 6/26/2026. Administrator further indicated that both S4 and S5 have not completed a medical assessment yet. S4 and S5 do not have proof of training in their file. Administrator indicated that S4 and S5 have not completed their job training orientation nor Dementia training since their initial hiring, which is 6/15/2026 for S4 and 6/26/2026 for S5.
Four (4) resident files were also reviewed. During record review, LPA did not observe an LIC 601/Identification and Emergency Information in R1's file. Staff indicated that they do not have it. The whereabouts of the form are unknown. R3 does not have a current medical assessment in place (Physician's Report). Last assessment was conducted on 6/27/2023.
Medication and documentation review was conducted for (4) residents. R2’s Quatiapine Fumarate 25 mg tablet, evening dose, was not given to resident on June 29, 2026. Medication observed in the bubble pack during inspection. Administrator stated that the facility uses Medication Administration Log (MAR) for resident medication management; however, R1 did not have a July 2026 MAR log in place. LPA observed Administrator take out a blank MAR log from a binder and then proceeded to fill in the July 1 and July 2, 2026 a.m. medication administration for R1’s Metformin tablets. Also, per administrator interview, R2 refused to take their Quatiapine Fumarate 25 mg tablet, evening dose on 6/26/2026, but did not document it correctly on R2's June MAR log. MAR June 26, 2026 evening dose was signed by staff as administered.
Per California Code of Regulations, Title 22, and California Health and Safety Code, deficiencies are noted and citations are issued. A Technical Violation note was also created. Exit interview was held with Vilma Trazo, Administrator, and a copy of the report, LIC 809-D (9) and Appeal Rights was provided.
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