Routine inspection·February 10, 2023

Licensing Program Analyst (LPA) Erik Gonzalez Campos arrived unannounced on 02/10/2023 to conduct a required - 1 year inspection. This inspection is focused on the infection control practices and procedures of this facility. LPA met with administrator, Alma Fuentes. LPA toured building and grounds which were clean and in good repair. Exits and walkways were free from obstructions. Facility had sufficient perishable and non perishable food. Toxins were kept locked and secured. Medications were kept locked and secured. Resident bedrooms were furnished as necessary. Bathrooms had necessary grab bars and non slip mats. Fire extinguishers were charged and current. Smoke and carbon monoxide detectors were present and operational. Staff and residents are fully vaccinated and boosted. High touch surface areas are disinfected daily. LPA observed 4 staff during the inspection. Interview with Staff 1 (S1) revealed that he does not have a valid fingerprint clearance and that he resides at the facility. S1 does not provide direct care for residents. LPA had a conversation with Napa Ombudsman and S1 during the inspection. LPA informed S1 that per regulation he cannot reside at the facility as a staff without a fingerprint clearance and association. S1 left the facility during the inspection. LPA and administrator reviewed regulation 87465 (Incidental Medical and Dental Care). Regulation requires record of each dose given of a PRN medication is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. Regulation does not require a medication administration record for other medications. Continued on LIC 9099C LPA is requesting the following documents be submitted to Community Care Licensing within 30 days of today's inspection: LIC 308 Designation of Facility Responsibility LIC 9020 Resident Roster LIC 500 Personnel Report Emergency Disaster Plan Evidence of Liability Insurance Admin Certificate Deficiencies 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. Appeal rights were provided. Exit interview conducted with administrator. Reports emailed to facility.