Routine inspection·January 17, 2025

At approximately 2:00 PM, Licensing Program Analysts (LPAs) Julie Florio and Ali Deniz arrived unannounced to conduct a required 1-year annual inspection and were greeted by staff. Cheryl Gambonini, Licensee/Administrator was contacted via telephone and arrived approximately 15 minutes later. Facility is a Residential Care Facility for the Elderly (RCFE) with four (4) residents in care, all of whom were present during today's inspection. Facility has a Dementia Care Plan, a Hospice waiver for three (3), and is approved for all non-ambulatory residents,. At approximately 2:30 PM, LPAs initiated a tour of the facility with Administrator and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPAs observed a supply of clean linens, and hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. LPAs observed at least 15 instances of expired perishable and non-perishable food items, (see LIC809D). Medications were centrally stored and locked. There is a shaded seating area in the front and backyards with outdoor space for activities. LPAs observed another structure which was locked and is used as a bakery and the contents of which is mostly baking supplies and holiday decorations. Resident were observed engaged in community word games during inspection. Facility has an internet access device available for resident use. Facility has internet service available to residents in care and the telephone was tested an operational during inspection. Continued on LIC809-C... Continued from LIC809C... Facility's 2 fire extinguishers were observed charged and were last serviced 12/2024. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Facility conducts bi-annual disaster drills, and the most recent drill was conducted 01/2025. LPAs informed Licensee that drill shall be conducted on a quarerly basis moving forward, and Licensee agreed to bring the facility into compliance. LPAs observed the facility's infection control plan, first aid kit, PPE, emergency supplies, and facility has a generator for emergency preparedness. LPAs reviewed facility's emergency disaster plan last updated 1/2025. At approximately 4:00 PM, LPAs conducted file review. Three (3) staff files and four (4) resident files were reviewed. All staff files reviewed were missing at least one (1) of the required documents, (See LIC809D). All staff have proof of required current First Aid certification. Four (4) of four (4) resident files reviewed were observed missing at least one (1) of the required documents, (See LIC809D). Administrator states that most of the residents' family members coordinate residents' medical and dental appointments and transportation to and from visits. However, Administrator is available to assist with this as needed. Medications and medication records were inspeccted and the logs were observed to not be maintained in compliance with regulation, (see LIC809D). Facility does not handle P&I. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit : LIC500 - Personnel Report (updated) Proof of Liability Insurance (Updated) 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. Appeal rights were given. Exit interview conducted with Licensee whose signature on form confirms receipt of documents.