Routine inspection·April 3, 2024

License Program Analyst's (LPA’s) Shannan Hansen arrived at 8:15 AM to conduct an unannounced annual inspection and was greeted by Rabah Abusbaitan, General Manager. There is a total of 102 residents, of which 23 dementia residents, and 13 residents under Hospice care. Facility tour/inspection began at 8:45 AM: LPA toured the community with General Manager and Maintenance Director Jose Herrera. The tour of the facility included nine resident apartments, activity rooms, Library, Salon, dining rooms, kitchen and outdoor patios. All interior parts of the facility were found to be a comfortable temperature measuring between 75 to 78 degrees F. Exits and pathways were free from obstructions. The assisted living residents also have an outdoor patio courtyard. Delayed egress doors from the memory care units (Lee’s Lane & Hogan’s Court) have audible alarms when doors are opened without access codes. Memory care courtyard was observed to have broken glass on ground (see pic & LIC809-D) glass was immediately removed by maintenance director. Hot water temperature measured within regulation of 105 to 120 degrees F in eight of nine rooms tested; although one memory care room did not have hot water only reaching 67 degrees F observed by LPA & General Manager at approximately 9:30 AM (see LIC 809-D), as well bathroom window was open and did not contain required screen (see pic LIC 809-D). Bathrooms contained necessary grab bars and showers contained non-slip floor/mats. While touring memory care kitchenette at approximately 9:36 AM LPA and General Manager observed a bottle of Clorox toilet bowl cleaner in unlocked cabinet (see pic & LIC 809-D), staff removed. LPA observed at least a minimum of a 2 day supply of perishable and 7 day supply of non-perishable food necessary for residents in care. Food was found to be handled and stored in a safe manner. Dining rooms and kitchen were inspected and maintained per regulation. Menus with snack and beverages are available to residents. Activity schedules are posted. Facility has a theater and multiple indoor and outdoor sitting areas and a private dining area. Continued on LIC809C Continued from LIC809 Fire extinguishers were last serviced 1/9/2024. Fire safety system including smoke detectors and carbon monoxide detectors and sprinklers were last tested by Central Marin Fire Dept. on 11/13/2023. LPA observed multiple smoke detectors and carbon monoxide detectors functioning. Disaster drills are conducted quarterly with the last being 3/26/2024. Facility has a permanently installed generator to power entire facility should there be a power outage. At approximately 10:45 AM, LPA reviewed 5 resident records and found 5 of 5 residents have current physician's reports and care plans. 5 of 5 records contained current and signed admission agreements and medication records are thorough and contained physician's orders for each resident. LPA reviewed centrally stored medication record and found to be in compliance. At approximately 12:30 PM, LPA reviewed 5 staff records. All records contained documentation of completed training as required. Evidence of current first aid and CPR training were present for required staff. All staff had required criminal record clearance and were associated. Staff (S1)’s records did not contain required health screening or TB results (see LIC 809-D). LPA Hansen is requesting Licensee to update and submit the following documents by 4/22/2024 to SRRO: LIC 308 Designation of Facility Responsibility LIC 500 Personnel Record LIC 610 Emergency Disaster Plan (if changes) Copy of Administrator Certificate Proof of Liability Insurance 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..