Routine inspection·March 14, 2025

At approximately 09:45AM, Licensing Program Analyst (LPA) Ali Deniz made an unannounced annual inspection of this licensed senior care facility. LPA met with facility Licensee/Administrator, Ermelinda Mahlman. There is a total of six residents at facility, two with dementia, and 1 resident on hospice. Facility is a 1 story building with 9 Resident bedrooms, 1 staff bedroom, 4 bathrooms, and common spaces. At approximately 10:00AM, 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 except the Complaint Poster PUB 475 was not posted in the facility (Technical Advice given). LPA observed activity supplies for resident use. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Staff were in the process of cleaning up after breakfast at the time of this inspection. During walk-though LPA/Administrator observed knifes were unlocked and administrator stated that they only clock the knife drawer and cleaning supply cabinets during the nighttime. Toxins are stored in a secure room of the kitchen. Although sharps and toxins in kitchen cabinets were unlocked (See LIC809-D page). Water temperature measured within regulation between 105- and 120- degrees F at faucets accessible to residents. Fire extinguishers inspected were charged and last inspection on 06/14/2024. Smoke detectors are hardwired into the fire system. Facility has fire sprinklers throughout. Fire suppression system was last inspected January 2024. Carbon Monoxide detectors were present. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure. At approximately 12:10PM, LPA reviewed 5 of 6 resident records and found 1 out of 5 resident R1 did not have current physician's reports or care plans. R1’s last medical assessment has done in Feb 2024 (Technical Advice given). Continued on LIC809-C... Continued from LIC809... At approximately 1:05PM, LPA reviewed 4 of 7 staff records. Based on file review, 3 out of 4 staff did not complete the required 20 hrs initial every year training (See LIC809-D page). At approximately 1:30AM, LPA reviewed the facility emergency disaster plan with Administrator. Licensee/Administrator was not able to find documentation or proof about when the facility conducted their last disaster drill (Technical Violation given). Facility has a generator to supply power during an outage. The plan outlines evacuation routes, which are shown on facility sketch and has alternative meeting locations. Facility has the required evacuation stair chairs in place. Facility has supplies enough to operate for more than 72 hours in an emergency. LPA was presented with proof of current CPR & 1 st Aid certification for 6 out of 7 staff. Later Administrator was able to provide proof of first aid certificate for S1. Administrator Certificate is for Ermelinda Mahlman #6022851740 expired 12/6/2024. However, administrator was able show the proof of renewal application records that she submitted on Oct 17 th , 2024. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Resident’s Copy of Updated Certificate of Liability Insurance Current Administrator Certificate Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809D, Plan of Corrections, and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.