The facility’s fire clearance is approved for six (6) non-ambulatory residents, ages 60 and over, of whom one (1) may be bedridden. The facility also maintains a hospice waiver for two (2) residents.

At the time of the inspection, one (1) residents were receiving hospice care.

Facility Tour & Observations:

Personal Rights postings (LIC 613C and Ombudsman), the Complaint Poster (PUB 475), and the nondiscrimination notice were observed posted in a common area. Residents had access to personal space, privacy, and adequate storage for personal belongings. No firearms or weapons were present at the facility. Oxygen signs were posted within the home.

Physical Plant:

The facility is located in a residential neighborhood and consists of a single-story home with six (6) bedrooms, one of which is a caregiver bedroom, bathrooms including one private restroom, a living room, family room, kitchen/dining area, a detached garage, a front yard, and a backyard. All resident bedrooms observed contained the required furnishings, including a bed, mattress, linens, dresser, chair, and adequate lighting. LPA observed that sharps were inaccessible to residents and stored in a secured kitchen cabinet. However, chemicals were observed to be accessible to residents in a restroom cabinet and a hallway cabinet. Civil penalties will be issued because the same deficiency is being cited again within one (1) year. Bathrooms were observed to need cleaning and were equipped with required safety features, including grab bars near toilets and bathing areas and non-skid mats. Toilets, sinks, and bathing fixtures were operational. The hot water temperature was outside the required regulatory range of 105°F–120°F. Extra linens and towels were available and stored in hallway cabinets. Smoke and carbon monoxide detectors were tested and found to be operational. Fire extinguishers were observed and available. No bodies of water were present on the premises. Passageways and exits were clear and unobstructed. The front and backyard areas were maintained and contained shaded seating areas for residents’ use. (continued on 809C)

• Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

• Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

Refrigerators and freezers were maintained at appropriate temperatures, with refrigerators observed at or below 40°F and freezers at 0°F. LPA observed an insufficient supply of perishable food to meet the two (2) day requirement for five (5) residents. The facility maintained at least seven (7) days of non-perishable food. Fresh produce, proteins, and dry goods were available for resident use.

Health-Related Services & Records:

Three (3) resident files were reviewed and contained documentation, including Admission Agreements, signed consents, Physician’s Reports documenting ambulatory status, and Resident Rights acknowledgments. R1’s and R3’s files did not contain physician’s orders for their bed rails. A deficiency was cited for the missing bed rail orders. Resident reappraisals were not observed in the files reviewed, and a technical advisory note was provided.

Medications and medication records for three (3) residents were reviewed. Medications were centrally stored and secured in a locked cabinet inside in family room.

Disaster Preparedness:

The LIC 610D Emergency Disaster Plan was available for review. Emergency supplies, including water, food, flashlights, batteries, and first aid supplies, were observed and available for use in the event of an emergency.

Personnel Records & Training

Three (3) staff files were reviewed and contained criminal record clearances. Required training documentation was not on file. S1’s and S2’s files did not contain current CPR and First Aid certificates, and S2’s file lacked documentation of TB screening. Deficiencies will be cited for these findings.

An exit interview was conducted with Vilma Melitado, Caregiver as Admin could not attend meet with LPA. During the inspection, deficiencies were observed and cited on the attached LIC 809D/809C in accordance with Title 22, Division 6 regulations. A copy of this report, LIC 809D/809C, and appeal rights will be provided.