Routine inspection·October 3, 2024

On 10/03/24 Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct a 1 year required visit. LPA was greeted ad granted entry by Caregiver Casandra Geurkink, where LPA explained the purpose of the visit. At the time of the visit there was (1) staff and (5) residents present. The facility licensed to serve (6) non ambulatory residents age range 60 and over. The facility also has an approved hospice waiver for (4), there is currently (0) residents receiving hospice care, and (1) receiving home health services. Senior Manager Brandee Geurkink arrived shortly after and accompanied LPA on a tour of the facility. The home is a single story structure consisting of 4 bedrooms and 2 bathrooms, garage, backyard, kitchen, living room and den. The facility was observed to be clean, with the passageways being from of any obstructions. The medications were observed to be locked and inaccessible to residents in care. The facility is using an electronic Medication Authorization Record (MAR) program. The facility food supply was observed to be sufficient as there was a 2 day supply of perishable and a 7 day supply of perishable food items. The facility was observed to have 2 fully charged fire extinguishers that were last services on 09/18/24. The facility does not have any pools or bodies of water on the premises, or no known guns or ammunition. The hot water was tested and found to be within regulatory limits measuring at 112.2 degrees Fahrenheit. There was no log available for LPA to review verify whether the facility is conducting emergency disaster drills on a quarterly basis as required. Deficiency cited. LPA conducted a review of both resident and staff files. The resident files were observed to have the required documentation such as physician's reports, and appraisals. All staff present were observed to have obtained criminal record clearance and to be associated to the facility. In addition to having valid CPR certification, The administrator Thomas Uata was observed to have a valid certificate that expires on 2/25/25. During today's visit LPA reminded about the facility annual fees that are due on or before 10/29/24, and provided the following pin 600382. It was also shared that the facility will be having the roof replaced, there are not currently any leaks, the roof is just in in need of an overall upgrade. Based on today's inspection a citation will be issued in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8) on the attached 809D. An exit interview was conducted and a copy of this report, appeal rights, Li 9098-Proof of corrections form was provided to Senior Manager Brandee Geurkink.