Resident Files: At 10:15am team conducted resident and staff records review. The following was observed. Five (5) out of 5 resident files were incomplete. Files were missing signed and completed Admissions agreements, Physician’s reports, resident preplacement appraisals/resident reappraisal, List of personal property, ID Emergency Sheets. Resident appraisals that were in the file did not have services explained and were missing signatures from the resident, and or responsible party. Please see LIC858 included with this report. Hospice and Home Health files are missing and or incomplete missing care plan, admissions, notes.

Staff Files: The following was observed. There are no completed personnel records for all six (6) staff members which include the administrator. All files were missing personnel records (LIC501), Health Screening/TB results (LIC503), Documented medications and general training not completed. Please see LIC859 included with this report.

With the assistance of the Licensee/administrator, a tour of the physical plant was initiated at approximately 11:00am and the following was observed:

Continue on LIC809-C

MEDICATION: LPA observed medication, staff/resident files, and First Aid kept inside the locked cabinet located office area near the kitchen. LPA observed First-aid kit is complete and has new manual. Facility has Dementia Care Program. LPA observed each centrally stored prescription and PRN medication has been logged in the medications log. Proper medication dispensing instruction are followed and checked for contamination. All medications are properly labeled and checked for expiration dates.

SMOKE DETECTORS/CARBON MONOXIDE. The smoke detectors and carbon monoxide are hard wired, inter-connected and were located throughout the facility. At 12:00pm they were tested and observed to be operational. The facility has one (1) new fire extinguishers that was purchased on 11/1/2024. The fire extinguisher is located in the hallway next to the kitchen.

SURROUNDING GROUNDS: The backyard of the facility has sufficient yard space and it’s fenced. Exit areas are free of obstructions and hazards, exit gates were unlocked and easily accessible. LPA discussed the importance of maintaining the care and supervision to meet the needs of residents. The facility has a swimming pool which is properly fenced and locked. There is no garage.

The following deficiencies were observed (see LIC809D) 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.