Routine inspection·May 15, 2024

Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct the Annual Inspection. LPA met with and explained the reason for the visit with Administrator (AD) Donna Hurley and Wellness Director (WD) Alexis Martin. AD re-certification was confirmed to be in process during the visit. During this visit, LPA toured the facility inside & out Resident rooms are found to be in good repair and contained required furnishings and lighting. The resident bathrooms was clean and in good repair with faucets delivering hot water within required limits, grab bars and non-skid shower floors observed. LPA observed required hygiene items, towels, extra bedding, and linens were stored and available for use. The kitchen was clean, with necessary items and appliances. LPA observed required food supply and paper product storage. Cleaning/disinfecting supplies, knives and sharps are locked and stored separate from food. Medications are locked and centrally stored in a medication cart. The First aid kit contained required items. There are visitation areas available inside and out. Doors and passageways are unobstructed throughout the facility. The Fire extinguishers were serviced by Valley Fire Co. on 4/5/2024. LPA conducted resident and staff file reviews. A medication audit was also conducted Emergency Disaster Plan and Infection Control Plans were reviewed during this visit and found to be updated. A deficiency is being cited in accordance with California Code of Regulations on the attached LIC 809-D in the area of: Hospice Care Waiver and Incidental Medical and Dental Care. An exit interview was conducted and Plan of Correction (POC) developed. A copy of this report was signed by AD and Appeal Rights were provided. LPA requested the following updated forms faxed to CCLD by 5/22/2024: Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Surety Bond (Lic402) , Emergency Disaster Plan (LIC610E), Client Roster (LIC 9020), Proof of current Liability Coverage.