KITCHEN: The LPA inspected the kitchen/food service area at 12:48 p.m. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and non-perishable food. Food labels were inspected and checked for dates and expiration dates and food labels had expiration date clearly marked. The knives and sharps are stored under the kitchen sink locked and inaccessible to residents in care. Cleaning supplies were also observed locked and inaccessible under the kitchen sink.

COMMON AREAS: At the time of the visit, living room, family room, and dining room furniture was observed to be in good condition. The LPA observed three residents watching television at the time of the inspection. The facility maintained a comfortable temperature. At 12:59 p.m., the smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguisher was observed to be in compliance and charged on 03/15/2023. The LPA observed a closet in the hallway with extra towels and linens. The LPA observed required postings throughout the common space. There is a working telephone on premises.

(Report Continued on LIC 809C...)

BACKYARD: The backyard has a covered outdoor area equipped with furniture for resident use. Emergency exits and passageways were observed free of obstruction. There was one (1) gate that self-latches. No bodies of water were noted at the time of the visit.

BEDROOMS: There are four (4) resident bedrooms. Two (2) bedrooms are single occupancy, and two (2) bedrooms are double occupancy. The LPA observed the resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting.

RESTROOMS: There are two (2) resident restrooms. The first restroom is located in the hallway and the second restroom is located in bedroom #4. Restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared. The hot water temperature was measured in both bathrooms and found in compliance between 105- and 120-degrees Fahrenheit at the time of the visit.

RECORDS: Records review began at 1:13 p.m.; six (6) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms.

At 1:45 p.m., Review of Resident #1’s (R1’s) medical assessment dated 09/25/2023 revealed that R1 has no capacity for self-care and is neither on hospice nor has the facility submitted an exception request to admit or retain R1 at the facility. The Administrator stated they would be submitting a request to the Department to retain R1 at the facility.

(Report Continued on LIC 809C...)

Three (3) personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were complete.

The current Administrator’s file was also reviewed, and it was complete.

The last emergency disaster drill took place on 10/30/2023.

MEDICATIONS: Medications review began at approximately 2:50 p.m.; medications are centrally stored in a locked cabinet adjacent to the dining room. All medications including PRNs were labeled, stored, and locked inaccessible to residents.

At 3:08 p.m., a review of Resident #2’s (R2’s) centrally stored medication revealed that R2’s medication for Hydrocodone was logged on the centrally stored and destruction medication record (CSMDR); however, the wrong prescription number was written down. Staff corrected prescription number at the time of the visit.

The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Failure to correct the deficiencies may result in additional civil penalties.

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