Amador Residential Care Facility

Allegation investigated: Facility staff are not feeding residents items that are on the menu. Facility staff are not ensuring that residents receive adequate food. Facility staff are not ensuring that residents receive showers according to schedule. Facility staff are not keeping accurate resident records. Facility staff are not meeting residents oral hygiene needs. Facility staff are not ensuring that residents are adequately hydrated.

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to the facility to conduct a complaint investigation. LPA met with Administrator Karly Sturgeon, and explained the purpose of the visit. The Department has determined the following as it relates to the above aforementioned allegations. The investigation consisted of facility observations, interviews with residents, interviews with staff, and records review. Facility staff are not feeding residents items that are on the menu. LPA Valerio observed the facility on 03/30/23, 07/27/23, 08/01/2023, and 09/07/2023. Residents were served plated meals that composed of a protein, vegetable, starch, and drinks. According to the Reporting Party (RP), the facility served residents sacked lunches. During LPA's visits, LPA did not observe any meals served in a sacked paper bag. Continued on LIC 9099 - C... Unsubstantiated Continued from LIC 9099 LPA interviewed staff. S8 stated kitchen staff follow the menu. S7 stated the kitchen staff do not follow the menu a lot and is not aware of the reason. S7 stated there is only one kitchen staff during PM shift, which could be the reason. S7 is aware AM kitchen staff help PM kitchen staff, but believes there should be another kitchen staff to assist with ensure quality meals are being produced. S6 stated they try to follow the menu as best as they can; however, it depends on the food items received from the store. Facility staff are not ensuring that residents receive adequate food. According to staff interviews, S1 believes the facility could offer a better variety of food due to residents being tired of the same food, S2 does not believe the allegation is true, S3 did not comment on the food, S4 did not provide information on food, S5 personally believes the food could be better, S6 currently eats the meals that are served, S7 would not eat the food being served and does not believe they offer quality food, and S8 says the food is perfect. According to five (5) resident interviews, 3 residents rated the food as good, 1 resident stated the chicken is bland with no flavor, and 1 resident could not comment on the food. Technical Assistance was provided. Facility staff are not ensuring that residents receive showers according to schedule Based on interviews with staff, staff stated showers are almost always completed and marked in the shower log. If a resident refuses to shower, it is documented in the resident chart. PM staff reported that they are constantly busy and reported an extra staff member would help with getting task done. Based on LPA's observations, LPA did not observe the facility to have a foul odor in the common areas or inside inspected bedrooms. During LPA's interview with residents, LPA did not observe resident's to be in clothing with stains and did not observe greasy or unkempt hair. During LPA's visits, floor staff were often busy assisting with resident care. Facility staff are not keeping accurate resident records. LPA reviewed resident records. LPA did not observe any documents missing or not within compliance of Title 22 regulations. All files were updated annually. There were updated notes regarding appointments, dietary changes, and care plans that reflected current information. Continues on LIC 9099 - C... Continued from LIC 9099 - C... According to an interview with Administrator Karly, the facility keeps paper charts and electronic charts. If an employee forgets to chart on the electronic file, administrative staff can cross check the paper charts. Paper charts are used first and then transcribed to the electronic portion. Administrator Karly stated there are 2 charts for compliance and audit purposes. According to RP, the staff fill in client charts even though a task was not completed. LPA could not find any information or observed any incidents to corroborate with the statement. Facility staff are not meeting residents oral hygiene needs. According to an interview with staff, there are only a few residents that need assistance with oral brushing. Staff will prompt residents to brush teeth or provided hand to hand assistance with brushing. LPA observed the facility ADL checklist log. Each resident has a personalized care plan for their needs. The care plan explains what the resident needs and how staff are to carry out the task. Once completed, the staff will mark if the resident has completed the task or staff assisted. Based on LPA review, there was not a time where staff did not sign off on oral hygiene. During LPAs interview with residents, LPA did not observe thrush inside the resident's mouth. Facility staff are not ensuring that residents are adequately hydrated. LPA Valerio observed the facility on 03/30/23, 07/27/23, 08/01/2023, and 09/07/2023. The visits revealed that the facility had a hydration station available for residents in care. Based on interviews with staff and LPA observation, activity staff prompt residents to drink water during snack pass in addition to caregivers assisting residents to drink the water. According to staff, the facility keeps track of fluid intake. The facility started to add fresh berries, cucumbers, or oranges to the water to increase water intake. Residents have reported that the water taste better with the addition of the fruit. Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore the allegations are unsubstantiated. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. Exit interview was held and a copy of report was left at the facility.the state’s words, verbatim · CDSS document, Sep 7, 2023 · control 27-AS-20230327083915

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct an annual required inspection. LPA met with Administrator Karly Sturgeon and explained the purpose of the visit. LPA and Administrator toured the facility to ensure compliance of Title 22 regulations. The facility has an Assisted Living side and a Memory Care side. Emergency exits were observed to be unobstructed. LPA measured the water temperature in 3 bathrooms. Water temperature reads between 105*F and 120*F in the bathroom and room temperature reads 74*F throughout the facility. LPA observed the facility to have adequate food supply. Facility has an emergency food and water kit. Resident rooms were sanitary and had the required furniture and furnishings. Technical assistance was provided for an empty memory care room, which had a mattress that was observed to have cracks in the middle due to long term usage. Administrator was advised that the mattress should be replaced before another resident occupies the room. No foul odors detected throughout facility. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was in good and working condition. LPA observed toxins, medications, and sharps to be locked away and inaccessible to clients. The facility has an outdoor shaded sitting area for residents and visitors located in the front of the facility. In the back of the facility, there is a gardening area, games, and areas for sitting. During the tour, residents were observed to be singing to music, playing balloon toss, being assisted with ADLs, and eating lunch. LPA reviewed resident files and staff files. LPA observed all files to be up to date with necessary documents. Emergency drills were completed and up to date. LPA spoke to residents and staff during the visit. LPA observed 3 Administrative staff, 1 Laundry staff, 3 Direct Care staff, 1 Medication Technician, 1 Activity Director, 1 Activity Assistance, 1 Maintenance staff, and 3 Kitchen staff. LPA requested and obtained the following documentation: LIC 500, Liability Insurance, LIC 610 Per California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies are being cited today. An exit interview was held, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 1, 2023

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to the facility to conduct a case management visit. LPA met with facility staff Hanna, and explained the purpose of the visit. LPA was later met by Administrator Karly Sturgeon. LPA followed up on 2 incident reports, 1 death report, and provided information on an exception request. An incident occurred with Resident 1 (R1) where R1 had an unwitnessed fall and was found by staff on the floor with blood. R1 was transported to the hospital and returned with no new orders. R1 was placed on fall monitoring and the facility implemented the chair monitor. LPA observed the chair monitor locate do on the wheel chair. There is a clip that gets attached to R1's shift collar and if R1 gets up, the alarm will sound. An incident occurred with Resident 2 (R2) where R2 had an unwitnessed fall and was found on the floor by staff. R2 was observed to have skin tears on elbow and forehead. R2 was evaluated by the hospice nurse. R2 was put on alert charting and has a chair alarm to notify staff. LPA received a death report for Resident 3 (R3). According to the administrator, R3 was on hospice and died of natural causes. Per California Code of Regulations (CCR) - Title 22 - no deficiencies were observed. An exit interview was held, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 27, 2023

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct a case management visit to follow up on various incident reports received. LPA met with facility staff, and explained the purpose of the visit. Resident 1 (R1) had a fall, which results in R1 landing on R1's back. R1 was sent out to Sutter Amador Hospital. According to staff, R1 returned with no major injuries. Facility records show follow up care was provided and R1 was monitored. The Regional Office received a death report for Resident 3(R3). The death report did not include cause of death or conditions related to death. LPA reviewed resident records and interviewed staff. LPA discussed with ADM Fleta regarding the completion of a death report. LPA to provide TA to assistant administrator Karly. An incident occurred wit Resident 4 (R4) and Resident 5 (R5). R4 was walking down the hall and walked by R5. R5 used an elbow and forearm to push R4, which resulted in R4 falling on the ground hitting R4's head. All responsible parties were contacted, in addition to the non-emergency and local PD. R4 sustained an injury of head; laceration of forehead. R4 was made a follow up appointment to have sutures removed. According to staff, Per California Code of Regulations (CCR), Title 22, deficiencies are being cited on LIC 809-D. Appeal Rights provided. Failure to correct deficiencies may result in civil penalties. An exit interview held, and a report was provided to facility staff. LPA also discussed information with Administrator Fleta Herndon via cell phone.the state’s words, verbatim · CDSS document, Feb 9, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Feb 10, 2023

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, ...This requirement was not met as evidenced by: Based on records review, the licensee did not ensure R4 was free from abuse while in the care and supervision of the facility, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 9, 2023

Plan of correction: Licensee stated staff have increased monitoring, are continuing to communicate with third party/responsible party, and will provide additional in-service training to staff. LPA to receive supportive documentation by POC due date.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct a case management visit. LPA met with facility staff, and explained the purpose of the visit. The facility added a memory care section in the facility when their sister facility, Jackson Gardens, closed in 2022. In order to serve residents with dementia, the facility must have a dementia care plan on file and comply with Title 22 regulations. The facility has been licensed since 08/25/1993. Their license stated the facility is licensed for: Age Range 60 and over. 49 ambulatory and non-ambulatory. Approval for 10 hospice residents at a time. Approved Plan of Operation for Total Care on File. Client group served: Elderly In order to confirm the facility is able to meet the needs of residents with dementia, LPA obtained a dementia care plan dated for year 2022. During the visit, LPA checked the following: · Facility has non-ambulatory fire clearance for each room for residents with Dementia · Updated Emergency Disaster Plan that addresses safety of residents with Dementia · Ensuring that there is adequate number of staff to supper residents needs per appraisal · Inaccessibility of devices or appliances that could harm a resident with Dementia · Inaccessibility of objects such as weapons, medication, cleaning supplies, etc,. During the tour today, there was 2:6 ratio for the memory care side of the facility. LPA did not observe devices or appliance that may harm a resident with dementia. LPA observed medications and cleaning supplies inaccessible to residents. LPA discussed information with Administrator Fleta via cell phone. LPA conducted an exit interview with facility staff, and provided a copy of the report.the state’s words, verbatim · CDSS document, Feb 9, 2023

Allegation investigated: Facility failed to assist resident with hygiene Facility failed to assist resident with feeding

Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to deliver complaint investigation findings. LPA met with Administrator Julie Kramer, and explained the purpose of the visit. The department has determined the following as it relates to following allegations: Facility failed to assist resident with hygiene, facility failed to assist resident with feeding LPA reviewed facility files. The facility had a food intake log for residents on the assisted living side of the facility. The staff members track the percentage of food and fluid intake for each meal. LPA observed the facility on 09/30/2022. LPA observed the facility to have 3 staff for the assisted living and 2 staff on the memory care side assisting residents with feeding throughout the meal times. During the visit, LPA also observed staff conducting rounds and assisting residents with ADLs. Continues on LIC 9099-C... Substantiated ...Continued from LIC 9099 LPA interviewed 4 staff. According to an interview with staff 1 (S1), all residents need some sort of assistance with ADLs and there are two residents on the lower level service side that require staff to feed them for all meals. S1 stated the facility has staff that are designated to feed the residents either in the dining hall or in their room. S1 stated staff also assist residents who need assistance with utensils. Staff will observe the residents for the duration of their meal time. The facility documents daily percentage of food intake on a sheet of paper, which is kept in the medication room. S1 does not know of any resident not being fed or hygiene not being attended to. According to Staff 2 (S2), there are two additional residents on the higher level service side that require assistance with feeding. S2 stated one resident recently needed to have services added to their care plan due to concerns raised by their family. S2 stated after services were added to their "Quick Mar" system, services were implemented right away. S2 stated, "the only time a person is not fed is if they refused to eat." Staff are to ask residents multiple times, save the plate, and document how much they ate or refused. According to S3 and S4, there was never a time where a resident did not get fed unless they chose not to eat. LPA Valerio received photo documentation for resident 3 (R3). LPA reviewed 4 pictures from July 4th, 2022 and 5 pictures from July 14th, 2022. LPA observed R3 to have a thick layer of oral thrush on the inside of R3's mouth. The thrush was an opaque/white color that was on the surface of the tongue, in between teeth, and on inside of the cheek. According to mayoclinic.org, "oral thrush is a condition in which the fungus Candida albicans accumulates on the lining of your mouth." To prevent oral thrust, mayoclinic.org recommends to rinse one's mouth, brush teeth twice a daily, floss daily, etc. According to the pictures, R3 suffered neglect due to the facility not ensuring to assist resident with hygiene needs. According to the responsible party for R3, R3 cannot speak; however, can communicate by answering yes or no questions. The questions are asked and R3 will squeeze the hand. When R3 was asked about food and hygiene, R3 answered yes to not being helped for feeding and yes to no one brushing teeth. Based on records review and interviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8) are being cited on the attached LIC-9099D. Failure to correct the deficiency may result in civil penalties. Appeal rights were provided. An exit interview was conducted, and a copy of the report was provided to Administrator Julie Kramer.the state’s words, verbatim · CDSS document, Sep 30, 2022 · control 27-AS-20220705135931

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(4) · Plan of correction due date: Oct 1, 2022

87464 Basic Services (f) Basic services shall at a minimum include: (4)Personal assistance and care as needed by the resident...such as.. eating... This requirement was not met as evidenced by: Based on records review and interviews, the facility did not ensure R3 was fed with the assistance of staff, which poses an immediate health and safety risk to resident in care.the state’s words, verbatim · CDSS document, Sep 30, 2022

Plan of correction: Licensee added updated care plan to R3's QUICK MAR prior to delivery of findings. Licensee stated the facility will re-evaluating residents needs and ensure needs are met by adding additional specific needs in Quick Mar system. LPA to receive an update on which residents had their care plan changed by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(1) · Plan of correction due date: Oct 28, 2022

87465 Incidental Medical and Dental Care (a) A plan...shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance...:(1) The licensee shall arrange,.. assist...medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by: Based on records review and interviews, the facility did not ensure R3 dental needs were met, which poses an potential health and safety risk to residents in carethe state’s words, verbatim · CDSS document, Sep 30, 2022

Plan of correction: Licensee stated an in-service for all staff will be conduct on Relias and have a person come in to provide training on oral hygiene and ADLs. LPA to receive supportive documents on in-service training by POC due date

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA's) Ruth Wallace and Kesha Lewis arrived at this facility to conduct a unannounced Required 1 Year Annual Inspection Visit. LPA's introduced themselves to Administrator and explained the purpose of the visit. A staff member opened the gate and LPA's were screened for COVID-19 symptoms with temperature at the medication window inside the facility. LPA's and Administrator toured physical plant inside and outside. Ensuring the safety of the residents and compliance with Title 22 regulations. LPA's also conducted the infection control domain tool. The facility has a LIC 808 mitigation plan. LPA's observed the facility to have COVID-19 informational signs posted throughout the facility. The facility is able to designated and dedicated a COVID-19 bedroom, bathroom, and isolation area if needed. The hot water measured 92.6 *F for room 22, and 94.0 *F for room 32, which was not within the regulatory range of 105 - 120 degrees F. Facility has nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. LPA's observed the centrally stored medications area, cleaning supplies, and sharps to be locked and inaccessible to clients. Resident rooms was sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguishers are current and last inspected on 11/23/2022. The facility has a front porch area that can be utilized for outdoor visits. All emergency exits were clear from obstructions. LPA's reviewed four (4) staff files. All staff is fingerprint cleared and associated to the facility and staff 1, 2, & 4 do not have current First Aid or CPR certifications on file. Facility is conducting initial and continuing training as required. LPA's reviewed four (4) resident facility files, COVID-19 Plan, and survey binder. All necessary documents were in place. LPA's observed the following posted on the facility wall: Facility license, sketch, See Something Say Something poster, Ombudsman poster, Theft and Loss Policy, Resident Bill of Rights, Rights of Resident/Family Councils. LPA's requested updated copies via email to LPA Wallace by August 15, 2022: LIC 308 - Designation of Administrator, LIC 309 - Administrative Organization, LIC 610E Emergency Disaster Plan, and Liability Insurance Per California Code of Regulations, Title 22, Division 6, one deficiency was observed during this visit and can be found on LIC 809-D. A civil penalty was assessed due to a repeat violation within one year. An exit interview was held with Administrator and a copy of the reports and appeal rights were left at conclusion of visit..the state’s words, verbatim · CDSS document, Aug 8, 2022

Allegation investigated: Residents are not bathed Residents are not changed timely Staff left resident in soiled clothing for extended period of time Basic laundry services are not being provided

Licensing Program Analyst (LPA) Christina Valerio and LPA Jamie Ivey-Canady arrived to the facility unannounced to deliver complaint investigation findings. Administrator Julie Kramer authorized facility staff to sign the final report. The department has determined the following as it relates to the allegations: Residents are not bathed, Residents are not changed timely, Staff left resident in soiled clothing for extended period of time, Basic laundry services are not being provided The investigation consisted of interviews with eight staff members (S1 - S8), two outside agencies (OA1 - OA2), and four residents (R1 - R4). According to S1, S1 observed residents not being cared for properly and informed management about observations. S1 stated there a handful of staff that want to come forward but can't due to the dynamics of upper management. Continues on LIC 9099-C... Unsubstantiated According to S2 and S3, they are unaware of any concerns relating to personal rights of the residents. According to S4, S4 reported that AM staff sit in the break room all shift and residents are left in soiled diapers. According to S5 and S6, the facility has ADL logs and a care system in place in order to ensure proper care is provided to all the residents. S6 stated S6 was surprised by the complaint because S6 felt the staff go the extra mile to care for residents. According to interviews with OA1 and OA2, OA1 and OA2 have visited the facility for a few years and have observed the interactions with staff and residents. OA1 reported no issues to be observed with OA1's client, which has resided at the facility for over two years. OA2 has a close relationship with a resident and has heard great things from the the resident. OA2 had a family member previously live at Amador Residential Care Facility and stated the staff were very kind and attentive to the family member. According to interviews with residents, residents are assisted and did not mention anything regarding staff not being able to assess with ADLs. According to records review of six resident files, LPA observed residents to have updated documents, including Activities of Daily Living (ADL) logs, Showering Logs, and set laundry schedule. LPA observed the ADL log to be signed every shift. Residents are assisted every 3 hours to be assisted with toileting and assisted every other day for showered. If any resident refuses and/or is unable to complete an ADL task for the hour, it is electronically logged by the staff. LPA observed the facility on 01/04/22 and 03/22/22. LPA observed laundry service being provided throughout the shift during each visit. Staff reported that the facility has a set laundry schedule for the day. However, if any resident has soiled laundry, the facility will wash the items on the same day. Based on all the information collected by the Department there is not a preponderance of evidence to prove the allegation occurred, therefore this allegation is UNSUBSTANTIATED. Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore the allegations are unsubstantiated. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. Exit interview was held and a copy of report was left at the facility. Page 2 of 2 ...Continues from LIC 9099-A LPA observed the kitchen. The oven, which is required to cook meats, vegetables, and baked goods, had knobs that were worn down to the point where numbers were missing. LPA requested staff to move heating trays from the heating table. LPA observed rust throughout the entire unit. LPA observed the warming plate heaters to be non-operational, which according to staff have not worked for a long time. According to S1, food is served cold and frozen and there are times where it takes a long time for meals to be served. S1 observed a time where fries were served frozen. S2 stated the food is not bad and recalled of one resident who has asked to warm their food up due to it not being at their preferred temperature. S3 stated there is one resident who has constantly stated food needs to be warmed up. S4 stated food is not prepared fresh. S4 stated most of the residents do not have the cognitive capacity to inform staff that their food is cold or not cooked. S5 stated that when the facility had a COVID outbreak, the food was getting to the residents cold because they were not able to use the warming trays. The food would be warm once it left the kitchen; however, it would get cold once it got to the end of the hall. S7 and S8 informed LPA that the knob for the kitchen oven does not have numbers to indicate cooking temperatures and they have to guess when they cook. S7 and S8 reported they use heat thermometers to check if meat is cooked. For other items, they judge the cooking times based on experience and observation. Based on observations and interviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8) are being cited on the attached LIC-9099D. Failure to correct the deficiency may result in civil penalties. Appeal rights were provided. An exit interview was conducted, and a copy of the report was left at the facility.the state’s words, verbatim · CDSS document, Apr 5, 2022 · control 27-AS-20220103112014

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(29) · Plan of correction due date: May 5, 2022

87555 General Food Service Requirements(b) The following food service requirements shall apply: (29) All equipment, fixed or mobile, and dishes, shall be kept clean and maintained in good repair.. This requirement was not met as evidenced by: Based on interviews and observations, the facility did not ensure ktichen cookware items were in good repair, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Apr 5, 2022

Plan of correction: Licensee stated the kitchen will be cleaned entirely and LPA will be kept updated with progress on obtaining new or updated kitchen applicances by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(9) · Plan of correction due date: May 5, 2022

87555 General Food Service Requirements (b) The following food service requirements shall apply:(9) Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. This requirement was not met as evidenced by: Based on interviews and observations, the facility did not ensure proper procedures were in place to ensure food was measured at a hot and warm temperature at all times due to equipment not working, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Apr 5, 2022

Plan of correction: Licensee stated all kitchen staff will receive in-service training regarding General Food Service Requirements and Food Handling. Licensee to send LPA Valerio in-service training sign in sheet by POC due date.

Type of visit: Required - 1 Year

On 08/20/21 at 11:18 AM, Licensing Program Analyst (LPA) Christina Valerio arrived at this facility unannounced to conduct an annual inspection visit. LPA Valerio introduced herself, explained the purpose of the visit, and was met by facility staff Brianna Caswell. LPA Valerio called prior to entering the facility. A staff member opened the gate and LPA was screened for COVID-19 symptoms with temperature at the medication window inside the facility. The physical plant was toured inside and outside to ensure the safety of the residents and compliance with Title 22 regulations. LPA also conducted the infection control domain tool. The facility has a LIC 808 mitigation plan. LPA observed the facility to have COVID-19 informational signs posted throughout the facility. The facility is able to designated and dedicated a COVID-19 bedroom, bathroom, and isolation area if needed. LPA observed the temperature inside the facility was measured at 74*F. The hot water was measured at 122 *F for room 24, 121.6 *F for room 22, 117.8 *F for room 38, and 111.6 *F for room 10. Room 24 and Room 22, was not within the regulatory range of 105 - 120 degrees F. Facility has nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. LPA observed the centrally stored medications area, cleaning supplies, and sharps to be locked and inaccessible to clients. Resident rooms was sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher is up to date with last check on 11/19/2020. The facility has a front porch area that can be utilized for outdoor visits. All emergency exits were clear from obstructions. LPA requested updated copies of documentation: LIC 500 personnel report, LIC 610E Emergency Disaster Plan, and Liability Insurance Per California Code of Regulations, Title 22, Division 6, deficiencies were observed during this visit and can be found on LIC 809-D. An exit interview was held and a copy of the report was left.the state’s words, verbatim · CDSS document, Aug 20, 2021

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.