Routine inspection·April 2, 2024

Licensing Program Analysts (LPAs) Kimberly Lyman and Rose Ruppert conducted an unannounced visit to Coloma Cottage. The purpose of today’s visit was to conduct the Annual Required inspection. LPAs were allowed entry into the home and met with Caregiver Anita Sacamay. Facility is licensed for 6 non-ambulatory residents, one of which may be bedridden. Facility has an approved hospice waiver for 6 residents and the home currently has 1 resident on hospice during today's visit. Maureen Salonga has an Administrator Certificate expiring on 10/24/2024. Caregiver Baldonasa arrived during the visit. LPAs along with Caregiver Audie Baldonasa toured the facility at 9:13 AM. LPAs toured the physical plant, checked food service, and the first aid kit. The home consists of four resident bedrooms, one resident bathroom, one shared hall bathroom, living room, dining room, and kitchen. Facility has a strong odor of urine upon entry. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed two residents with half bed rails. Resident bathrooms were checked. At 9:20 AM, LPAs observed unsecured cleaning supplies in the facility bathroom. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 112.6 and 115.5 degrees F in all facility bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Resident hygiene supplies are locked and inaccessible to residents. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including tweezers, thermometer, and scissors. During today's visit, auditory door alarms are operational. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen drawer. Smoke detectors and Carbon Monoxide detectors are hardwired and tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPAs toured the outside grounds and exit gates are unlocked and unsecured. LPAs observed emergency food and water supply in the facility. LPAs reviewed the emergency disaster plan during the visit. Plan is thorough and complete. Facility provided documentation of CONT ON LIC 9099C DATED 04/02/2024 last fire drill conducted in 2022. Facility provides activities in the form of games and exercise. At 10:00 AM, LPAs reviewed five resident files and four staff files. Resident files contained required documents including admission agreements, current physician reports and resident appraisals. Staff files reviewed did not contain required documentation of annual training. Staff 1 is not associated to the facility. At 11:00 AM, LPAs reviewed medication storage and administration. Medications are stored in a locked cabinet and are audited monthly by staff. Medications are being administered per physician order. Based on the observations made during today's visit, the following violations are being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report as well as appeal rights were discussed and provided with facility representative.