Post-licensing visit·March 23, 2022

Licensing Program Analyst (LPA), Farhaan Sarangi arrived at Cogir of San Rafael unannounced for the purpose of conducting a Post-Licensing inspection. LPA was greeted at the door by Administrator, Carol Dowell and Health Director Victoria Mozzafari. LPA toured the facility with the Administrator and the Health Director. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguisher was found to be last charged on April 2021. The kitchen fire extinguisher was last charged on June 2021. Facility smoke detectors detectors are hard wired and sound directly to the fire station. Carbon Monoxide detectors were tested and found to be operational on all floors. Disaster Drills were conducted March 22, 2022. There are emergency lights in many of the fixtures in the common areas of the facility that come on should a power outage occurs. Hot water temperature measured within Title 22 acceptable regulation of 105 to 120 degrees F in residents rooms. The facility has special care plan of operation and programming for residents with dementia. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food is available for residents any time of the day. Egress doors and elevator were operational during the inspection. Menus are available and provided during meals. LPA observed that provisions are made for individuals with special dietary needs; facility keeps a variety of items on the menu, and facility has a board in the kitchen with a picture of the resident & a list of dietary needs. There is a daily activity schedule for residents on floor #2. Medications were centrally stored and secured. First Aid kit was appropriately filled. Toxins are stored in the laundry room. LPAs advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Facility has already been N95 Fit tested. Staff has had training on PPE and PPE is sufficient in the facility. (Report continued on LIC 809C) LPA requested the following documents be sent to CCL: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 610E-S Supplemental Emergency Disaster Plan for RCFE LIC 9020 Register of Facility Client’s/Resident’s Copy of Administrator Certificate(s) Copy of Certificate of Liability Insurance No deficiencies observed or cited during today's Post Licensing inspection. Exit interview was conducted and a copy of this report was emailed to the Facility Administrator and Health Director, Victoria Mozzafari.