Routine inspection·October 23, 2024

At approximately 9:10AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1-Year Required Visit and met with Licensee/Administrator, Pilar De Olave. Facility serves residents with dementia and has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance and capacity for 5 residents, where 4 can be non-ambulatory. Facility has an approved hospice waiver for 2 individuals. Upon arrival, LPA was informed that there were 3 Residents in care and 1 staff member on-site. At approximately 9:30AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 9:45AM, LPA conducted a walk-though of the facility. LPA observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility has an Infection Control Plan on file. Facility is a 1 story building with 4 Resident bedrooms, 2 bathrooms, and common spaces. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for Residents. Mattress pads were in place or available for Resident use. Toxins were observed to be stored inaccessible to Residents. Fire extinguishers were last inspected April 2024. Smoke detectors and carbon monoxide detectors were tested and operational. At approximately 9:50AM, LPA reviewed staff files and resident files. All files were all found to be well organized, thorough and contained the required documentation. Staff files had current First Aid and CPR certification. Administrator's Certificate for Pilar De Olave (6030062740) was expired as of December 2021. Per Licensee, they have been unable to complete their in-person Continued Education Units (CEUs). Licensee informed LPA that they have not submitted an application to the Department to renew their certificate for this reason. LPA informed Licensee to submit their application for renewal. During visit, LPA observed Licensee begin to fill renewal application out (deficiency cited, see LIC809D, regulation 87405(a)). Continued on LIC809C Continued from LIC809 LPA unable to complete Annual Inspection. Annual Continuation Visit to be conducted at a later date. 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, LIC809D, Plan of Corrections, and Appeal Rights discussed and provided to Licensee/Administrator. Signature on form confirms receipt of documents.