Routine inspection·August 15, 2023

At approximately 9:30AM, Licensing Program Analysts (LPAs) Felias and Rummonds arrived unannounced to conduct a Required 1 Year Visit and met Business Office Manager, Karina Vasquez and Memory Care Director, Nate Howland. Executive Director in Training, Christine Mancuso, arrived at approximately 11:45AM. Facility is a Residential Care Facility for the Elderly that provides care and assistance for Older Adults in Assisted Living and Memory Care. Facility has an approved fire clearance for 81 Non-Ambulatory Residents, and 14 Bedridden Residents for a total capacity of 95 Residents. Facility has a Hospice Waiver for 10 individuals. Upon arrival, LPAs were informed that there were 20 Residents in Memory Care and 17 Residents in Assisted Living for a total of 37 Residents. LPAs were also informed there were 16 staff members on site. At approximately 9:45AM, LPAs reviewed the staff roster with Memory Care Director. During review, LPAs discovered that Staff Member 1 (S1), Staff Member 2 (S2) and Staff Member 3 (S3) were not fingerprint cleared or associated to the facility per regulation (This Deficiency has been cited, See LIC809D, Regulation 87355(e)) . LPAs also discovered that 2 staff members, Staff Member 4 (S4) and Staff Member 5 (S5) were fingerprint cleared, but not associated to the facility as required. LPAs contacted the Regional Office and confirmed the fingerprint clearance and association statuses of all 5 staff members to the facility. S1, S2, and S3 were informed of their status and they immediately left the premises. Facility sent the association paperwork for S4 and S5 to the Regional Office today, 08/15/2023. LPA confirmed with the Regional Office that the paperwork had been received. Administrator understands that S1, S2, and S3 cannot be on the premises of the facility until they have been properly fingerprint cleared and associated to the facility as required. **Executive Director in Training understands that a Civil Penalty is not being issued today for S4 and S5 because their association paperwork has been received by the Regional Office to be processed.** At approximately 10:50AM, LPAs conducted a walk through with Executive Director in Training and Maintenance Director, Jose Garcia. LPAs observed the following: Facility is comprised of 4 floors with two floors being designated for Memory Care, and two floors designated for Assisted Living. The facility has multiple common areas, activity spaces, and offices. Continued on LIC809C Continued from LIC809 Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Toxins were observed to be stored inaccessible to Residents. 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. A sample size of 12 sinks were tested. LPAs found that hot water temperatures were within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility's fire extinguishers were last inspected October 2022. Facility has a hard wired fire alarm and sprinkler system that is directly connected to the local Fire Department. Smoke detectors and carbon monoxide detectors were last tested in May 2023. LPAs also discussed the recent change in management for the facility. At this time, a new Executive Director has been hired, Jessica Gram. Until Jessica starts their employment, Interim Executive Director, Morgan Ware, is available in the event of an emergency or resident incident. Per conversation with Executive Director in Training, Facility has ensured that all staff know to contact Jessica or Morgan if any questions arise. LPAs are requesting the following Administrator paperwork for Jessica Gram: Administrator Documents · LIC 308 (Designation of Facility Responsibility) · Active and Current Administrator Certificate · First Aid Certificate · Administrator Resume · LIC 500 (Personnel Report) · LIC 501 (Personnel Record) · LIC 503 (Health Screening Report - personnel) · Proof of TB test · LIC 9182 (Criminal Record Exemption Transfer Request) · LIC 508 (Criminal Record Statement) · Copy of Driver's License or Passport that is not expired · Copy of Board of Directors' Resolution meeting minutes signed (required for all corporations) Continued on LIC809C Continued from LIC809C Documents to be submitted to CCL by due date of Friday, 08/25/2023. 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. **An immediate civil penalty in the total amount of $1,500.00 has been issued for a lack of criminal record clearance as required for S1, S2, and S3 (See LIC421BG).** LPAs unable to complete the Annual Inspection. Annual Continuation Visit to be conducted at a later date. Exit interview conducted. Copy of report, LIC809D, LIC421BG, LIC811 (Confidential Names), Plan of Corrections, and Appeal Rights discussed and provided to Executive Director in Training. Signature on form confirms receipt of documents.