Routine inspection·June 25, 2022

Licensing Program Analyst (LPA) Jaclyn Avila arrived at the facility unannounced on 06/25/2022 to conduct a Required 1 Year Inspection utilizing the infection control domain, LPA met with Roland Loewen (Administrator) and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Masks. LPA and staff toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, three (3) resident bedrooms, five (5) bathrooms, and kitchen. In the areas toured potential health, safety, or personal rights violations were observed. LPA and staff completed the infection control domain and Administrator was provided with technical advisories which will be corrected no later than July 1st, 2022. LPA will conduct a case management visit to ensure compliance. LPA observed the fire extinguishers to be last serviced September of 2019. Administrator agreed to have them serviced annually and will have them serviced no later than July 1st, 2022. LPA observed the resident records were incomplete and 2 of the 3 residents need updated LIC 602s. Administrator agrees to have this complete no later than July 8th, 2022. LPA has requested the following documents to be provided to Community Care Licensing Department (CCLD) by COB 6/30/2022 via email and/ or fa x (530) 895-5934. Infection Control Plan LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 309 ADMINISTRATIVE ORGANIZATION No citations issued. Exit interview conducted.