Facility Evaluation Report
Licensing Program Analyst (LPA) Salia Walker conducted an unannounced Case Management- Deficiencies inspection visit at the facility today due to deficiencies observed during a initial complaint visit, control #29-AS-20220113115003.
During today’s visit, the LPA attempted to interview resident #1 (R1) at 1:35 p.m. and once more at 4:15 p.m. Staff, and the administrator confirmed that R1 needs to be assisted with repositioning. A review of R1’s file revealed that R1 is paralyzed, bedbound, and required maximum assistance. R1 is currently residing in room #1 which is fire cleared for non-ambulatory only. The facility currently has the room numbers on the resident bedroom doors differing from the Facility Sketch, and room #1 at this time is displaying a #4 not in accordance with the Fire clearance nor submitted Facility Sketch. The LPA advised the administrator that the facility has an approved Fire clearance for five (5) non-ambulatory residents total in rooms 1 (shared), 2 (shared), and 3 (shared); and, one (1) bedridden resident only in room #4 (private). The LPA also advised the Administrator that this is a fire clearance violation due to the facility’s acceptance and retention limitations, Title 22 Regulation section 87202 Fire Clearance; 87455(c)(4)(g) Acceptance and Retention Limitations; 87208 Plan of Operation and H&S CODE 1569.72. At 1:29 p.m., the LPA observed two holes on the wall in the private restroom of room #3. The LPA advised the administrator that the facility shall always be in good repairs, and inquired regarding fixtures. The administrator acknowledged, and stated she did not have knowledge of the two holes on the wall and will be repairing them. At 1:42 p.m., the LPA observed common restroom in hallway had a broken toilet seat. The administrator stated she will have the toilet seat replaced. The LPA advised the administrator that the broken toilet seat is not safe, and shall be in good repair at all times. The administrator agreed, and acknowledged.
The following deficiencies were observed (See LIC 809-D), and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Immediate Civil Penalty assessed for Fire Clearance Violation.
Exit interview conducted. Appeal rights discussed, and a copy of the report and appeal rights were provided .
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction