Facility Evaluation Report

At 10:20 a.m. on 02/14/2024, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with staff and later the administrator and disclosed the reason for the visit.

A file review was conducted prior to the visit.

LPA and administrator toured the facility inside and out. No immediate health and safety risks were observed.

The facility was last visited on 07/17/2023 for an annual inspection. It is a single story building with six (06) bedrooms, four (04) bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for 6 nonambulatory residents. Approved hospice waivers for one (01).

At 10:45 a.m. LPA conducted a records review of resident and personnel records. During review of resident records, LPA noted the medical assessment’s of Resident #1 (R1) and Resident #2 (R2) both denoted they were bedridden. The administrator reviewed the documents with LPA and stated the medical assessment of R2 was done quickly and incorrectly. The administrator assured LPA that R2 was non-ambulatory and confirmed several other errors on R2’s assessment. The administrator agreed to obtain a new medical assessment for R2 as soon as possible. The administrator called the licensee at 2:00 p.m.to discuss the care of R1 since the facility’s fire clearance allows only non-ambulatory residents. This deficiency related to the facility operating beyond the capacity of its fire clearance is cited on the attached LIC 809-D page. A $500 immediate civil penalty is assessed today for the violation of the facility’s approved fire clearance. The administrator was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) or (f), or 1548(e) or (f), 1568.0822(e) or (f).

At the main entrance, LPA observed a maintained front yard with stairs leading to the main entrance. Postings were observed for confidential complaint contacts, ombudsman contacts, personal rights, rights of resident councils, nondiscrimination notice, neighborhood grievance procedure, emergency disaster plan, facility license, facility sketch, administrator certificate, and a blank copy of an admission agreement. Signs showing “No smoking – Oxygen in use” were posted at the main entrance and on the doors of Bedroom #4 and Bedroom #5.