Facility Evaluation Report

At approximately 8:25AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1-Year Required Visit and met with Staff Member, Andrea Dela Chica. Licensee/Administrator, Bot Alicdan, arrived during visit at approximately 9:00AM. Facility serves older adults and has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance and total capacity for 13 residents of which 11 residents can be non-ambulatory, and 2 residents can be bedridden. Facility has an approved hospice waiver for 3 individuals. Facility has approval to have a locked perimeter. Upon arrival, LPA was informed that there were 9 Residents in care and 2 staff members on-site.

At approximately 8:45AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were not associated to the facility per regulation. LPA confirmed on the Guardian website that the two staff members were background cleared but not were associated to the facility as required (deficiency cited, see LIC809D and LIC421BG, regulation 87553(e)). At approximately 9:25AM, LPA conducted a walk-though of the facility with Licensee. Per Facility sketch, facility is a one story building with 11 bedrooms, 11 bathrooms, and common spaces. LPA observed the following: facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Mattress pads were in place or available for Resident use. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. Hot water temperatures for 7 of 13 facility sinks were found to be out of compliance with Title 22 Regulations of 105 to 120 degrees Fahrenheit, measuring between 120.5F to 126.8F (deficiency cited, see LIC809D, regulation 87303(e)(2)). During walkthrough, LPA observed the following toxins, hazards, and medications to be accessible: unlocked knife drawer in the kitchen, Disinfectant cleaner in the bathroom, bed bug repellent in a cabinet located in the dining room. LPA also observed blood sugar monitors and sharps located in the facility's dining room drawer, and 3 bottles of cough syrup, 1 bottle of Pepto Bismol and 1 bottle of Tums in a resident's room. Review of resident's LIC602 stated that resident has a dementia diagnosis and is unable to manage their own medications (deficiencies cited, see LIC809D, regulation 87705(f)(2)). Licensee immediately collected all toxins and ensured that they were locked and inaccessible. Licensee also removed medications from resident's room.