Routine inspection·October 14, 2025

At approximately 10:10 AM, Licensing Program Analyst (LPA) Shannan Hansen arrived unannounced to conduct a required 1-year annual inspection and was greeted by Staff. Administrator, Frank Nola, was contacted and arrived at approximately 11:00 AM. Facility is a Residential Care Facility for the Elderly (RCFE) with 23 residents in care. Facility has a Dementia Care Plan, is approved by San Anselmo Fire District for 14 ambulatory & 11 non-ambulatory residents, bedridden residents on first floor only, and has a Hospice waiver for 5. Facility currently has three (3) Hospice resident in care. At approximately 10:20 AM, LPA initiated a tour of the facility with Staff Walter and observed the following: Facility is a two story converted convent, was a comfortable temperature, and passageways were free from obstructions. LPA observed an evacuation chair at each stairwell for emergency prepairdness. Water temperatures in 6 of 6 residents' bathrooms/communal bathrooms measured, within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA 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. LPA observed menu posted throughout the facility, and facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency Food and water supply. Medications were centrally stored and locked in two med carts. There is a shaded seating area in the backyard with outdoor space for activities. LPA observed two (2) locked sheds in backyard which LPA inspected and observed the contents to consist of PPE supplies, extra resident care equipment, holiday decorations, chemicals and tools. Continued on LIC809-C... Continued from LIC809C... Facility's fire extinguishers were observed charged and were last serviced 6/2024 (see LIC9102TA). Smoke and Carbon Monoxide detectors were tested and operational during inspection. Centralized Fire system is inspected annually. Facility conducts quarterly disaster drills in different shifts with the last being 8/28/2025. At approximately 12:15 PM, LPA conducted file review. Six (6) resident files and six (6) staff files were reviewed. Six (6) of six (6) resident files reviewed contained the required documentation per regulation. However, Resident 1 (R1) was missing signed admissions agreement & Signed Personal Rights (see LIC809D); Residents (R2, R3, & R4) were either missing or had reassessments/care plans that were from 2023, (see LIC809D). All staff files reviewed have all of the required paperwork except Staff 1 (S1) was missing proof of negative TB results and Health screening was unled gable (see LIC9102 TA). All staff had proof of CPR and First Aid training as well as Annual required trainings. Administrator states residents' families coordinate residents' medical and dental appointments and transportation to and from visits. Medications were reviewed and observed managed and maintained within regulation. Administrator Certificate for Frank Nola #6072967740 exp. 1/5/2027. Appeal Rights Given. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal rights provided. LPA Hansen is requesting Administrator to update and submit the following documents to CCL by 11/7/2025: LIC 308 Designation of Responsibility (if changes) LIC 309 Administrative Organization LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (only if changes) LIC9020 Resident Roster