Routine inspection·April 7, 2023

At approximately 8:45 AM, Licensing Program Analyst (LPA) Shannan Hansen made an unannounced annual required inspection of this licensed senior care facility. LPA met with Licensee Leni Stayman & House Manager Anna Marshall. At approximately 9:00AM, LPA toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. During kitchen inspection LPA observed knives & seizors in unlocked drawers(see LIC809-D) Toxins are stored in a locked storage closet although during today's inspection LPA observed cleaning/disinfecting supplies in unlocked closet.(see LIC809-D). Water temperature measured 121.1 degrees F.,out of regulation between 105 and 120 degrees F at faucets accessible to residents (see LIC809-D). Fire extinguishers inspected were charged. Smoke detectors were found to be in working order. Facility has fire pull stations. Carbon Monoxide detectors were present. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure, although LPA found pre-poured medication in kitchen locked cabinet (see LIC809-D). At approximately 10:15AM, LPA reviewed 3 of 6 resident records. 6 of 6 records contained current and signed admission agreements and physician's orders on file. Medication records are thorough and contained physician's orders for each resident. Hospice care plans were up to date for each hospice resident. LPA interviewed 2 residents during this inspection. At approximately 11:00 AM, LPA reviewed 3 of 6 staff records. Evidence of current first aid and CPR training were current. All staff either had Covid-19 vaccination documents or exemptions on file. TB test results were missing from 4 staff records (see LIC9102 TV) LPA interviewed 2 staff during this inspection. Continue on LIC809-C At approximately 12:30 PM, LPA reviewed the facility emergency disaster plan with staff. The plan outlines evacuation routes, which are shown on facility sketch and has alternative meeting locations. Facility has supplies enough to operate for more than 72 hours in an emergency. Facility conducted and documented a disaster drill on 03/13/2023 Administrator certificate is being changed to Licensee's Leni Stayman which expires 10/09/2024. 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 Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LPA received documents at visit: LIC 500- Personnel Report LIC 610 Emergency Disaster Plan Copy of Administrator Certificate Copy of Certificate of Liability Insurance Grant Deed / Trust Deed/ Control Of Property . Copy of Administrator Certificate with required documents Licensee will be sent to CCL with LIC200