The LPA 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.

KITCHEN: The LPA began the inspection in the kitchen/food service area at 9:02 a.m. Knives are stored in a locked drawer in the kitchen. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 9:03 a.m., the LPA observed perishable items in poor condition – mustard (expired 11/2022), barbecue sauce (expired 12/2022), two cream cheese containers (expired 5/2023). These items were discharged upon observation. At 9:10 a.m., the hot water temperature was measured in the kitchen at 113.1 degrees Fahrenheit.

COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detector were operational at the time of the visit. The fire extinguishers were fully charged and were last serviced 6/15/2023. All exits have functioning auditory devices and were operational at the time of the visit. The LPA observed required postings throughout the common space.

The backyard has a covered outdoor area equipped with furniture for resident use. The LPA observed two (2) self-latching gates with clear passageways clear of obstruction. There were no bodies of water noted. There is a separate laundry room, which is kept locked. The garage is accessible through the laundry room. There was emergency food and water in the garage which was observed to be in good condition. Cleaning supplies and disinfectants are kept in locked cabinets in the garage.

Report Continued on LIC 809C...

RESTROOMS: The two resident 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. The hot water temperature was measured; the first bathroom measured at 114.2 degrees Fahrenheit at 9:14 a.m.; and the second bathroom measured at 108.5 degrees Fahrenheit at 9:20 a.m.

RECORDS: Records review began at 9:40 a.m.; six (6) resident records were reviewed for the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, appraisals, and current needs and services plan. All records were in order. The LPA reviewed three (3) staff files for, but not limited to, the following: personnel records, health screening, criminal record statements, and current first aid certification. Although the facility had a designate training binder, the LPA was unable to determine the number of hours completed per regulation for the past 12 months. The LPA also audited the current Administrator’s file, and it was in order.

The LPA obtained the following documents: LIC500 Personnel Report, LIC9020 Client Roster, emergency disaster plan, and liability insurance.

MEDICATIONS: Medications review began at 1:20 p.m. The medications are centrally stored and locked in a closet in the hallway. Medications are labeled and checked for expiration dates. At 1:37 p.m., the LPA observed Resident #4 (R4) medication to be pre-poured for the duration of the week. At 1:50 p.m., and 2:23 p.m., the LPA observed medication for Resident #1 (R1) and Resident #6 (R6) not being properly documented on the centrally stored medication and destruction record (CSDMR). The staff added the medications to the CSDMR at the time of visit.

Report Continued on LIC 809C...

INFECTION CONTROL: Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. At this time, the staff will continue to keep up signs that promotes good hand hygiene and symptoms of COVID. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of an infectious disease. The facility’s policies and procedures as it pertains to infection control are adequate.

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

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