During the walk through of the facility at approximately 11:05 a.m., the LPA observed that a resident in bedroom # 2 was in bed with full bed rails. The bed rails were raised at the time of the visit. When the LPA asked the administrator to provide the doctor’s orders for the full bed rails, the administrator was unable to provide the documentation and/or doctor’s order for the full bed rails.

Continues on LIC 809C...page 2.

• 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.

At approximately 11:35 a.m. the LPA observed the following physical plant areas in disrepair. Bedroom #3 closet has a hole inside the closet near the ceiling, which appeared to be in size about 12” X 12” inches wide. The bedroom window was stuck and could not be open for fresh air. The window blind is missing two vertical slats, allowing for the light to shine through. At the time of the observation the resident had a piece of clothing hanging by the top of the blind to keep the light from shining in. Per the resident, the next-door neighbor’s outdoor light shines through at night, and it disturbs the resident’s sleep. Bedroom #2 also has vertical blinds slats missing. The window facing the street is missing the window screen, consequently the residents don’t open the window to not let mosquitoes in. The LPA noticed that fire extinguisher which is located by the doorway of the kitchen and the common area, did not have a receipt with the date of purchase. When the LPA asked the administrator for the receipt, the administrator could not provide one.

During the physical plant inspection of the facility’s kitchen, at approximately 12:19 p.m., the LPA observed bananas in the pantry area; the bananas were extremely spoiled. The LPA observed the brown bananas to be inside a plastic bag, with liquid spilling from the plastic bag, when the LPA moved the bags, several small cockroaches scurry away. Furthermore, upon inspection of the refrigerator, the LPA observed a bag which had old, spoiled bread, and boxes of cookie dough with the expiration date of 11/10/2025.

Inside the refrigerator, the LPA observed several boxes and bags of insulin pens in the refrigerator that belonged to two (2) residents of the facility. The insulin pens were in between other food items, and accessible to residents in care. During the inspection of the insulin pens, the LPA interviewed the staff (S1) present and asked who administered the insulin to the residents, the staff replied that they did. When the LPA asked if the staff were qualified staff (LVN, RN) to administer the insulin injections, the staff replied, “No, but the administrator said we could”.

Continues on LIC 809C... page 3.

Two (2) people who identified themselves as facility staff were on the premises caring for the residents during the course of the investigation. Upon inspection of the staff files, it was observed by the LPA that the two people caring for the residents did not have background clearance, were not associated with the facility per the department’s personnel summary report and had not received the required training by the CCL department.

Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties.

Citations were issued. Exit interview conducted, and a copy of this report and appeal rights were provided.