Beginning at 12:30PM, the LPA, along with Facility Designee toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed:

Fire extinguishers was observed to be fully charged but last serviced 03/04/2022. Facility Designee brought a newly purchased fire extinguisher upon arrival at the facility.

BEDROOMS: There are 6 (six) total bedrooms, of which 4 (four) are private resident rooms, 1 (one) for shared resident use, and 1 (one) is designated as a staff room. Staff room was observed to be unlocked at the time of the visit. LPA reminded Facility Designee that all medications and any other items that could be a hazard to the residents need to remain locked, whether by keeping the staff room door locked or the items in a locked cabinet inside the unlocked staff room. The LPA observed the resident bedrooms, although under construction, were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.

RESTROOMS: The LPA observed 3 (three) restrooms in the facility. 2 (two) are for shared use, however at the time of the visit, 1 (one) shared restroom is under construction and is non-functional. The third restroom is designated as a private restroom and is also under construction and non-functional. The 1 (one) functional resident restroom was observed to be clean and sanitary and in operating condition with grab bars and non-skid surfaces. Water temperature was measured in the shared resident restroom and measured within the required range.

Report Continued on LIC 809-C

KITCHEN: Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Cleaning supplies were observed to be in an under-sink cabinet with locks, however, keys were left in the locks and the locks were unlocked, rendering the cleaning supplies accessible to residents in care. Knives were observed in a drawer with a lock engaged, however the keys were in the lock, leaving the knives accessible. Emergency food and water was observed. Garage was observed to be under construction.

OUTDOOR SPACE: The backyard has a covered outdoor area equipped with furniture for resident use. At 01:09PM, the exterior exit gate was observed to be locked. Additionally, due to the construction, passageways were cluttered. Outdoor laundry room was observed and contained chemical storage, but is inaccessible to residents in care.

RECORD REVIEW: Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. 5 (five) resident records reviewed were complete and contained all required documents. 5 (five) staff files were reviewed. Staff #1(S1) has been employed since 11/03/2023 and did not have a fingerprint background clearance associated to the facility. S1 filled out their staff file documents during today's visit. 3 (three) of 5 (five) staff files reviewed did not contain sufficient training documentation.

INFECTION CONTROL/EMERGENCY DISASTER PLAN: Not reviewed during today's visit.

MEDICATION REVIEW: Medications are stored in 2 (two) cabinets, both containing a lock. However, at 11:55AM, the keys were left in the lock, with one medication cabinet open, and were therefore accessible to residents in care. Medications for 2 (two) residents were observed. Both 2 (two) of 2 (two) residents' medications were observed to be maintained and administered in compliance with regulation.

Report Continued on LIC 809-C

Pursuant to Title 22 CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Civil penalty issued for $500. Facility Designee was informed that failure to correct the deficiencies may result in additional civil penalties.

Exit interview conducted. A copy of the report and appeal rights were provided.