Routine inspection·March 18, 2025

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Coloma Cottage. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was 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 10/24/2026. Caregiver Audi Baldonasa and Administrator Maureen Salonga arrived during the visit. LPA along with Caregiver Sacamay toured the facility at 7:52 AM. LPA toured the physical plant, checked food service, and the first aid kit. Facility appears clean and sanitary upon entrance. The home consists of four resident bedrooms, one resident bathroom, one shared hall bathroom, living room, dining room, and kitchen. 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. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 122.3 and 125.2 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. 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. At 8:10 AM, LPA observed unsecured sharps and pre-poured medications in a kitchen cabinet (photos). 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. LPA toured the outside grounds and exit gates are unlocked and self latching. There is ample outdoor shaded seating for residents. LPA observed emergency food and water supply in the facility. LPA reviewed the emergency disaster plan during the visit. Plan is thorough and complete. Facility provided documentation of CONT ON LIC 9099C DATED 03/18/2025 last fire drill conducted on 02/12/2025. Facility provides activities in the form of games and exercise. At 8:45 AM, LPA reviewed four resident files and three staff files. Resident files contained required documents including admission agreements, current physician reports and resident appraisals. Staff files reviewed contained required documentation of health screen/ TB, criminal record clearance and CPR/ first aid training. One out of three staff do not have required staff training. At 9:15 AM, LPA reviewed medication storage and administration. Medications are stored in a locked cabinet. 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.