At 10:30am LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, other common areas, and outside of the facility to ensure compliance with Title 22 regulations. Facility is a single-story home with a fire clearance to serve elderly residents and hospice approved for one (1). Facility has 5 resident bedrooms, one staff bedroom and 3 bathrooms for resident use. Bedroom #3 is a shared bedroom and has its own bathroom. Bedroom #4 on the facility sketch is fire cleared for ambulatory resident only. LPA observed 2 bathrooms to contain grab bars, non-skid flooring, shower chairs, close lid trash containers and hygiene supplies. Resident bedrooms were sanitary, furnished, well-lit and had adequate space for resident’s belongings.

The facility common areas are cleaned and furnished. Facility has a dining area off the kitchen and a formal living room. Fireplace was observed to be screened and not in use. In the kitchen area, LPA observed the kitchen to be sanitary and free of clutter. Additionally, the kitchen knives and other sharp objects are kept locked under the kitchen sink and not accessible to residents. Toxins and cleaning supplies are also kept locked under the kitchen sink. LPA observed the facility to have adequate food supply with at least 2 days’ worth of perishables and 7 days’ worth of non-perishables. LPA observed the laundry room to be sanitary and observed cleaning detergents to be locked and inaccessible to residents. Inside the garage, LPA observed paint containers accessible to residents. However, the garage door was observed to be locked but residents can unlock and access it from the inside.

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Water temperature reads 118*F and room temperature reads 76*F. Smoke and carbon detectors were tested and operable. Fire extinguisher was serviced on 4/5/24. Medication storage area was observed to be locked and inaccessible to residents in care. Medication records were reviewed and in compliance with regulation. First aid kit was observed to have adequate supplies and accessible to staff.

During this inspection 6 resident records and 3 personnel records were reviewed for regulatory compliance. Staff records contained required contents including staff training requirements. Staff noted on LIC 500 contained criminal background clearances. Resident records reviewed contained required contents including updated admission agreements, medical assessments, and updated appraisal forms as required. Through record review, it was revealed that a resident with non-ambulatory status was placed in a bedroom that was not fire cleared for non-ambulatory resident. LPA reviewed facility’s disaster plan to ensure regulatory compliance. Evidence of quarterly fire drills was Immediately not available for review during this visit. ADM faxed a copy of the last 2 fire drill log to the facility. Technical assistance was provided to document quarterly drills and always maintain documents in the facility and readily available for review upon request.

Note that LPA conducted the inspection using the CARE tool. The facility has an approved infection control plan in place. LPM requested an updated copy of current Liability Insurance, LIC 308, LIC610D and LIC 500.

Per California Code of Regulations, Title 22 and Health and Safety Codes, the following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in civil penalties.

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