Facility Evaluation Report

Licensing Program Analysts (LPAs) Ashley Smith and Elsie Campos arrived at the facility unannounced at 10:30 a.m. for an annual continuation. The ann ual was initiated on 1/26/2022. The LPAs met with Administrator Janyce Pink and explained the reason for the visit.

PERSONNEL RECORDS: Personnel records were reviewed from 11:00 a.m. – 11:50 a.m. The LPAs reviewed ten (10) files for but not limited to: job application, health assessments, criminal record statements and clearances, first aid certification, applicable training. The following was observed: four out of ten staff (S1, S2, S4, S5) did not have a medical assessment with tuberculosis screening results, and three out of ten care staff (S2, S3, S5) require an up-to-date first aid certification. The Administrator’s Certificate expires 6/10/2023. In addition, whereas the facility had training documents for staff, they were not in order at the time of the visit. Technical violation issued.

RESIDENT RECORDS: Resident records were reviewed from 12:05 p.m. to 1:00 p.m. The LPAs reviewed nine (9) files for, but not limited to: admissions agreements, medical assessment, needs and service plans. Out of the nine files reviewed, four out of nine residents (R1, R2, R3, R4) needs an updated appraisal.

MEDICATI O NS : Medications review took place from 1:30 p.m. – 2:30 p.m. Medications are located locked and inaccessible in the medication room. The LPAs conducted a medication audit for five (5) out of nine (9) residents. Within the audit, one out of five residents (Resident #5) has a medication that is being administered, but could not be located at the time of the visit.

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. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided. Administrator Janyce Pink was notified of the report findings; staff Jessyca Munoz was authorized to sign the report.