Routine inspection·May 27, 2025

At approximately 2:00pm, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and was greeted by staff. House Manager, Anna Marshall and Licensee, Leni Stayman were contacted via telephone and arrived at facility at approximately 2:15pm. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care, all of whom were present during today's inspection. Facility has a Dementia Care Plan, a Hospice waiver for four (4), is approved for all non-ambulatory residents, and is vendored with the North Bay Regional Center (NBRC). Facility has a Department approved secured perimeter. At approximately 2:30 PM, LPA initiated a tour of the facility with House Manager and Licensee and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. LPA observed egress devices activated on all facility doors. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, and hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. There is a shaded seating area in the front- and backyards with outdoor space for activities. LPA inspected a locked garage in the backyard which contained care equipment, supplies, food, a water and a back up generator for emergency preparedness. LPA observed residents watching TV and coloring in the common area. Facility has internet service and an internet access device designated for resident use. The telephone was tested and was operational during inspection. Continued on LIC809-C... Continued from LIC809C... Smoke and carbon monoxide detectors were tested and operational during inspection. Fire extinguisher was observed fully charged and was last inspected 04/2025. Emergency Disaster Plan was reviewed and updated 04/2025. Facility conducts quarterly disaster drills with the most recent drill conducted 04/2025. At approximately 3:15pm, LPA conducted file review of four (4) staff and five (5) resident files. Four (4) of four (4) staff files reviewed contained all the required documents, proof of training and proof of current First Aid and CPR certification. Five (5) of five (5) resident files reviewed contained all the required documentation. House Manager and Licensee state that since the majority of the current residents are on Hospice, they are cared for in the facility by medical professionals. However, they do assist with coordinating medical and dental appointments as well as transportation to and from appointments when residents have the need. Medications and medication records were inspected and the logs were observed maintained in compliance with regulation. P&I was observed stored and maintained in compliance with regulation. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit : LIC400 - Affidavit Regarding Client/Resident Cash Resources LIC402 - Surety Bond Exit interview conducted with House Manager whose signature on form confirms receipt of documents.