Facility Evaluation Report
On 10/3/23 at approximately 2:40pm Licensing Program Analyst (LPA) Jennifer Fain arrived at this facility unannounced to continue an annual inspection visit. LPA met with Homaira Momen and explained the purpose of the visit.
During this inspection 4 of 6 resident files and 6 of 6 staffing files were reviewed for regulatory compliance.
Staff files contained required contents including staff training requirements. 1 of 6 Staff files was missing a signed Criminal Record Statement. All staff noted on LIC 500 contained criminal background clearances.
Resident files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required.
LPA observed the 602 for Resident 2 (R2) stated bedridden status. The facility Plan of Operations does not address bedridden care. LPA observed the facility is licensed for 6 non-ambulatory with 6 hospice waivers, but does not have bedridden status. Technical Assistance (TA) was provided regarding fire clearance and waivers. LPA observed R2 at the dinner table. Licensee will confirm bedridden status and apply for clearance and waivers as needed.
LPA observed the 602 for Resident 5 (R5) states R5 has dementia and is “at risk if allowed direct access to personal grooming and hygiene products.” LPA observed hygiene products in R5’s room and shared bathroom. TA was provided and products were removed.
LPA observed cameras in 2 of 6 resident rooms and two in the common areas of the residence. The cameras in the resident rooms were removed immediately. LPA provided (TA) regarding cameras in residence. Cameras must be addressed in the Plan of Op and admissions agreement. Licensee states Plan of Op will be updated and an addendum to the Admissions agreement will be signed by each resident or responsible party.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction