Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor passageways. However, LPA Brown observed outdoor passageways not free of obstruction. Deficiency will be issued. The facility is maintained at a comfortable temperature of 75 degrees Fahrenheit. LPA Brown inspected resident bedrooms; they are equipped with mattresses, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA Brown observed sufficient lighting throughout the facility. However, LPA Brown observed missing one (1) night stand on Room #3 and missing chairs on all resident rooms. Technical Violation will be issued. LPA Brown measured and observed the water temperature in the bathroom to be at 98.9 degrees Fahrenheit. Deficiency will be issued. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Fire extinguisher was also observed at the facility. Posters such as personal rights, the CCLD complaint poster, ombudsman poster, and the disaster plan were posted in a common area. During the tour of the facility, LPA Brown observed one (1) window screen in disrepair. Technical Violation will be issued. ***Continuation in LIC809C ***

Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine Cabinet with the resident’s medications locked. LPA Brown observed a complete first aid kit and first aid book at the facility. However, LPA Brown observed the facility does not have the required emergency supplies, food and water. Deficiency will be issued.

Food Service: More than seven (7) days’ supply of Non-perishable foods and more than two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care.

Care & Supervision: The facility has an Administrator present at the facility with appropriate and enough hours to appropriately manage the facility. However, based on staff interview and records review, LPA Brown observed no night staff scheduled to work the night shift, awake and on duty, not sleeping at the same time as the residents as required for facility with dementia residents. Deficiency will be issued.

Record Review: LPA Brown observed the facility has an updated Liability Insurance. However, LPA Brown observed no Infection Control Plan developed by the Licensee at the facility. Deficiency will be issued. LPA Brown reviewed three (3) resident files for admission agreements, updated physician reports, pre-placement appraisals, centrally stored medication list and needs and services plans. LPA Brown observed no pre-admission appraisal completed for Resident #1 (R1) and Resident #3 (R3) and Resident #2 (R2) pre-admission appraisal does not have the required R2's responsible person signature. Deficiency will be issued. Also, LPA Brown observed no completed Preplacement Needs and Services Plan for Resident #2 (R2). Deficiency will be issued. LPA Brown reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test result. LPA Brown observed that files reviewed were complete.

Per records review, LPA Brown observed that the facility were issued the same deficiency for CCR 87303 Maintenance & Operation (e)(2) and HSC1569.695 Other Provisions (e)(2) on 12/28/2023 therefore ***Continuation. in LIC809C***

Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC809), LIC809D, LIC9102TV, LIC421FC and Appeal Rights were discussed and provided to Licensee/Administrator Maria Araceli Undan.