Community Care Licensing
Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. The facility is equipped with operating carbon monoxide alarms and fire alarms. Posters such as personal rights, the CCL complaint poster, in the common area.Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a variety of food available for clients. Dishes, cups, and utensils were also stored properly.
Deficiencies that were found during facility tour: LPAs inspected residents’ bedrooms; R1 and R2 had mattresses, nightstands, storage space, but did not have chairs. During facility tour, LPAs observed two electric wires hanging off of the wall by residents’ bedrooms, this is fire hazard for residents in care. R1 and R2 did not have non-skid mats inside their bathroom tub. LPAs tested residents’ water; the temperature tested at 126 F. No cautions warning signs posted. In addition, during facility tour, LPAs observed the facility kitchen hallway, living area, resident’s hallways and (2) resident’s bedrooms did not have light installed nor lamps for appropriate lighting. LPAs inspected kitchen cabinets, (8) kitchen cabinets were dirty, with food crumbs and dirt. Furthermore, LPAs observed the window located by the dining area did not have a window screen install. LPAs and S1 tested facility phone, the phone was out of service. During facility tour, R1 and R2 bathroom was not free from incontinence odor. Next, LPAs tested exit monitor device for residents with dementia. The devices were turned off. The facility currently has (1) dementia residents, facility must always remain devices on.
Document Has Been Signed on 10/16/2024 02:35 PM - It Cannot Be Edited
Delicacies that were found during record review: LPAs observed the facility did not have their Plan of Operation in their facility file and no Disaster Plan 610. In addition, R1 did not have their hospice care plan in file, and R2 did not have their annual medical assessment which is required for dementia resident. Furthermore, R1 did not have (1) of their medication listed on their MAR and did not have their PRN documented with the time, date, and resident response. Lastly, during criminal record clearance check, LPAs observed S1 is not associated to the facility. The licensee was advised to submit transfer request.
Deficiencies that were found during care & supervision: The facility does not have sufficient staff coverage, based on the LIC500 the staff members that were scheduled were not present. During staff interview, S1 stated they will be working over 24 hours. During facility annual inspection, the facility did not have a designated staff present, house manager or Administrator present. Moving forward the licensee shall ensure the facility has designated staff present or Administrator present for 24 hours as stated in Tittle 22 Regulations.
Based on observations today, a civil penalty in the amount of $500.00 dollars will be issued for not transferring S1 criminal record clearance. The facility will be issued (11) Type A deficiencies and (12) Type B deficiencies per Title 22, Division 6, of the California Code of Regulations.
An exit interview was conducted, and this report (LIC809) was discussed to Licensee Sandy Zhao on the phone and was provided to caregiver Karim Ibarra Morales along with a copy of LIC809D, LIC421BG, and the appeal rights.