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25 | Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 12/17/23 at 10:30am to conduct a Required -1 Year visit. LPA met with Grace Tolentino and stated the purpose of the visit. Grace Tolentino, administrator certificate expires 8/8/24.
LPA was allowed entry into the facility that is licensed to serve 6 non-ambulatory residents of which 3 may receive hospice care services. There are 2 receiving hospice care services during this visit. Annual Fees are current. The facility staff roster provided during this visit. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. The temperature inside the facility was observed to be at 76 *F which is within the required range of 68-85*F. The hot water temperature was measured at 114.3*F which is within the required range of 105-120*F. LPA observed fire extinguisher(s), pull alarm system, smoke and carbon monoxide detectors in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents.
LPA observed the food supply and storage requirements of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days on the premises. LPA observed the knives and chemicals to be locked. The facility has wall heaters and a wall air conditioner. LPA observed residents engaged in individual activities during this visit. Grace Tolentino contacted Administrator Ana Dayeh regarding todays visit and inquired about the infection control plan. Ana Dayeh inquired if LPA is asking for the LIC9282. LPA did not observe an Infection Control Plan in the facility during this visit. However, at 12:55pm, Ana Dayeh provided the completed Infection Control Plan to Grace via email to print out for the facility records. The first aid kit was found in compliance containing at least the following: a current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency, sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, and antiseptic solution. LPA observed 2 staff, 2 resident files and conducted interviews during this visit. LPA reviewed regulations regarding food, Infection Control Plan, Staff and Resident files, and Care Tool. Upon a file review the following items were discussed to be submitted with any changes annually: Any addendums to Infection Control Plan (LIC9282), Designation of Facility Responsibility (LIC308), Control of Property, Personnel Report (LIC500) to include the Administrator presence in the facility, Administrator Certificate-Updated, Emergency Disaster Plan (LIC610E), Liability Insurance. Per CCR-Title 22, Div.6, Ch. 8, no deficiencies cited. Exit interview conducted, copy of report given. |