Routine inspection·April 23, 2024

On April 23, 2024, Licensing Program Analyst (LPA) Shannan Hansen made an unannounced annual required inspection of this licensed senior care facility. LPA met with Administrator Carisma Patterson. Facility has 3 residents, all on hospice. At approximately 8:45 AM, LPA and Administrator 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 although Administrator was informed a copy of facility Admissions Agreement is to be posted in public view per Regulation 87507( e)(2) (see LIC9102). The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Toxins are stored in a locked storage cupboard. Water temperature measured 119.4 degrees F and 133.8 degrees F., falling out of regulations between 105 and 120 degrees F in 1 out of 2 faucets accessible to residents (see LIC809-D). Administrator adjusted water heater during visit. There was a supply of cleaners, hygiene products and paper products available for residents. Bathrooms were equipped with necessary grab bars and non-slip floors/mats. Fire extinguishers were last inspected 5/9/2023. Smoke detectors were found to be in working order. Carbon Monoxide detectors were present and also in working order. There was enough lighting in all common areas, resident rooms, and hallways. LPA observed activity supplies, puzzles, and newspapers for resident use. Medication is centrally stored and secure in individually locked cabinets in garage. At approximately 10:00 AM, LPA reviewed 3 of 3 resident records and found 3 of 3 residents have current physician’s reports although 3 of 3 residents did contain required updated Reappraisals/care plans indicating change of conditions (see LIC809-D). 3 of 3 resident records contained current and signed admission agreements. Continue on LIC809-C At approximately 11:20 AM, LPA reviewed 4 of 4 staff records. 4 of 4 records contain documentation of completed training records as required. Evidence of current first aid and CPR training were observed. Medications were centrally stored in locked cabinet in the facility laundry/lounge room. At approximately 1:15pm LPA observed facility has not kept a log of Centrally Stored Medication Record (CSMR) (see LIC809-D) Facility has a generator to supply power during an outage. Facility has supplies enough to operate for more than 72 hours in an emergency. Facility records indicate they conduct quarterly disaster drills with the last disaster drill conducted on 3/10/2023. Administrator informed they changed over to logging in licensee’s laptop after 3/10/2023 and that is not available at this time (see LIC809-D). Carisma Patterson Administrator Certificate 6060960740 expired 10/27/2023 LPA was presented proof of trainings & Certificate submission. LPA reviewed Licensing Information System (LIS) with Licensee who stated that is correct and updated at this time; no need to change any of the information other then facility number to change with mobile. 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 LPA Hansen is requesting Licensee to update and submit the following documents to CCL by 5/10/2024: LIC 308 Designation of Responsibility (if changed) LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (if changed) LIC 9020 Register of Facility /Resident’s Control of Property – Deed Copy of Administrator’s Certificate Proof of Liability Insurance