The facility is a four (4) bedroom, two (2) bathroom home with a kitchen/dining area, living room/activity room, laundry room and an attached garage. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) non-ambulatory residents of which one (1) may be bedridden. The facility’s approved for six (6) hospice waiver. The current census is five (5) residents. LPA Brown was accompanied by Licensee/Administrator Nguyen to conduct a general overall inspection, which included, but was not limited to the following:

Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 72 degrees Fahrenheit (F). LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. However, LPA Brown noted that there's no non-slip mat in residents' shared bathroom. Deficiency will be issued. LPA Brown observed sufficient furniture and lighting throughout the facility. LPA Brown measured and observed the water temperature in the resident bathroom to be at 110.8 degrees F. The facility is equipped with operating combined smoke detectors and carbon monoxide alarms. Charged fire extinguisher was also observed at the facility. Posters such as personal rights, the CCLD complaint poster, Ombudsman poster, and the disaster plan were posted in a common area. ***Continuation in LIC809C ***

• 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.

There is a medicine cabinet with the resident’s medications locked. LPA Brown observed a complete first aid kit and first aid book at the facility. Moreover, LPA Brown noted that the facility has the required emergency supplies, emergency food and emergency water maintained at the facility.

Food Service: More than seven (7) days’ supply of non-perishable foods and more than two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care.

Care & Supervision: The facility has an Administrator present at the facility with appropriate and enough hours to appropriately manage the facility. The facility has sufficient number of staff to provide care and supervision to the residents in care. LPA Brown noted that the facility has a staff scheduled to work at night, awake and on duty as required for facility with dementia residents.

Record Review: LPA Brown noted that the facility has an updated Infection Control Plan, Emergency Disaster Plan and updated Liability Insurance. LPA Brown reviewed three (3) resident files for admission agreements, updated physician reports, pre-placement appraisals, centrally stored medication list/physician orders and needs and services plans. LPA Brown observed resident files reviewed were complete. However, LPA Brown noted that Resident #1 (R1) has a half bed rail and per records review, R1 does not have written order from R1's physician indicating the need for half bed rail for mobility. Deficiency will be issued. LPA Brown reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test result. LPA Brown noted that the Licensee did not ensure that the hospice agency staffs provide the required training to facility staffs for the implementation of the hospice care plan. Deficiency will be issued.

During medication audit, LPA Brown observed that Staff #2 (S2) did not assist Resident #1 (R1) with one (1) medication per R1's physician's order. Deficiency will be issued.

Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, Chapter 8 of the California Code of Regulations (CCR).

An exit interview was conducted, and this report (LIC809), LIC809D, LIC9102 and Appeal Rights were discussed and provided to Licensee/Administrator Jennifer Nguyen.