Overview: Facility is a one-story home located in a residential neighborhood. Facility is licensed to serve up to 6 elderly residents; up to 6 may be non-ambulatory. Facility has a clearance for one bedridden. Bedroom #2 on the facility sketch was approved for one bedridden use. Facility does not have clearance for delayed egress, and secured/locked perimeter. Facility has a hospice waiver for 6 residents.

Upon arrival: LPA observed the room temperature to be at 70 degrees Fahrenheit. All 6 residents were present with 2 staff on duty. The fire door was observed to be propped open with a door stopper. This was a deficiency last year. Per Fire Inspection (STD850), it specify that the fire door needs to be closed.

Physical Inspection: Areas that were inspected include, but not limited to, the resident bedrooms, bathrooms, kitchen area, dining room, other common areas and outdoor areas.

LPA and staff inspected 5 of 5 resident bedrooms, one staff room and 2 resident bathrooms. Hot water temperature was measured in one of the bathrooms, and it was at 1119.3 degrees Fahrenheit. Advisory provided to lower the hot water temperature just a little.

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• 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.

The outdoor area was inspected, and the fences and gate were observed to be in good repair. No bodies of water were observed. The LPA noted a shaded area with appropriate outdoor furniture available for client use. An advisory was provided, reminding the facility to ensure all staff are familiar with the location and operation of utility shut-off valves in case of emergency.

Record Reviews: Documents that were reviewed include, but not limited to, resident files, staff files, and other pertinent facility records.

Review of 4 of 6 resident file(s) was conducted, including but not limited to, review of Admission Agreement, Physician Reports, and Ambulatory Status. Advisory was provided to ensure the facility update Restricted Health Condition Care Plan for those residents with restricted health conditions. Advisory was provided for facility to obtain home health care plan and training records from the home health agency.

Review of 3 staff files included but not limited to background clearance, first aid/CPR certification, and training. Advisory provided for facility to update their training on Hoyer lift operation.

Facility conducts monthly Fire Drills. Advisory was provided to conduct other types of disaster drills as required, such as earthquake and flood. Advisory was provided to administrator to ensure they review their infection control plan and emergency disaster procedure plan at least annually and document each review.

Interviews: 1 staff member was interviewed and 1 resident was interviewed.

Documents Requested: LPA obtained a copy of updated Liability Insurance, Personnel Records (LIC500), and Designation of Facility Responsibility LIC308.

Per the California Code of Regulations, Title 22, Division 6, Chapter 6 and Health and Safety Code, deficiencies were cited. Civil penalties are being assessed in the amount of $500 for the fire door. Advisories were provided.

Exit interview was conducted with AD. A copy of the report and appeal rights was provided.

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