Routine inspection·January 9, 2024

On 1/9/2024 at 9:00 AM License Program Analyst (LPA) Hansen arrived unannounced to conduct an annual visit of the facility. LPA was welcomed by Administrator Linda Mahlman. There is a total of 6 residents at facility, two with dementia, and no residents on hospice. At approximately 9:10 AM, LPA toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a visible area. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Toxins are stored in a secure room off of the kitchen. Although sharps and toxins in kitchen were observed by LPA & Licensee unlocked on 1/9/2024 at 9:15am (see LIC809-D). Hot water temperature measured between 105.6 degrees F and 117.6 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 1 of 3 resident’s bathroom faucets. Facility has 8 fire extinguishers throughout, all charged on 5/4/2023. Smoke detectors and Carbon Monoxide detectors were checked and in working order. Facility has fire sprinklers throughout. Fire suppression system was last inspected January 3, 2024. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure in locked cabinets in room area behind kitchen/office. At approximately 10:00 AM, LPA reviewed 6 of 6 resident records and found 6 of 6 residents records contained current appraisals and signed admission agreements. Although 1 of 6 residents records did not contain current physician reports (LIC602) (see LIC809-D). Medication records are thorough and contained physician's orders for each resident. At approximately 11:00 AM, LPA reviewed 3 of 3 staff records. 3 of 3 records contained documentation of completed training as required. Evidence of current CPR training provided, although 3 of 3 staff could not provide current 1 st Aid Certification (see LIC 809-D). LPA interviewed 2 staff during this inspection. Continue on LIC 809-C At approximately 11:45 PM, LPA reviewed the facility emergency disaster plan with staff. Facility has a commercial generator to supply power during an outage for entire facility for over a week. The plan outlines evacuation routes, which are shown on facility sketch and has alternative meeting locations. Facility has supplies enough to operate for more than 72 hours in an emergency. Facility has conducted and documented quarterly disaster drills with the last being 10/12/2023. LPA reviewed Licensing Information System (LIS) with Lisignee who stated that is correct and updated at this time; no need to change any of the information. Administrator Certificate is for Ermelinda Mahlman #6022851740 expires 12/6/2024. Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided. LPA Hansen is requesting facility to submit the following documents to CCL by 1/25/2024: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Resident’s Copy of Certificate of Liability Insurance