Routine inspection·June 22, 2023

Licensing Program Analyst(LPA) Alviso conducted a Required-1 Year visit, on 6/22/23 at approximately 10:25am, and met with Administrator Kim Humphrey. Hospice care waiver approved for sixteen(16) residents. Facility has an approved dementia plan of operation. Facility has submitted the required Infection Control Plan, which is part of the facility's plan of operation. Facility has a required emergency disaster plan, including evacuation. Last fire drill was 6/15/2023, per review of records. Fire clearance approval is for 86 non-ambulatory residents, which includes 10 bedridden. Rooms approved for bedridden use are 117, 118, 119, 120, 121, 134, 136, 137, 138,139. Facility is two stories with both assisted living and memory care. LPA toured the facility with the Administrator. All exits were unobstructed. All fire extinguishers randomly checked, were serviced and tagged as required, expires 8/11/23. All stairwells, three(3), had evacuation chairs as required. Medications were locked and inaccessible to residents in care. All toxins were locked up and inaccessible to residents as required. The facility was at a comfortable temperature. The facility had sufficient lighting in common areas, hallways, and bathrooms for use by all. Resident rooms checked, had sufficient lighting, grab bars, and non-skid flooring/bath mats for use by residents as needed. Facility had supplies to meet the 72 hour shelter in place requirement. Hot water was checked at 108.3F which is within regulation requirements. Facility had a sufficient supply of perishable and non-perishable food. Continued on LIC809C..... LPA reviewed five(5) resident files. All resident files were found to be complete. LPA reviewed five(5) staff files, including training. All staff have criminal record clearance as required. Three(3) out of five(5) staff lacked current first aid certification, S1, S3, and S5, all three staff provide direct care to residents. This deficiency will be cited, 87411( c)(1) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69. Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross, see LIC809D. Administrator to submit updates of the following documents by 7/22/2023: LIC 500 Personnel Summary LIC308 Designation of Facility Responsibility Copy of Liability Insurance LIC 610 Emergency Disaster Plan (If changes) Infection Control Plan (If changes) 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. Exit interview conducted with the Administrator. Appeal rights provided to the Administrator.