Routine inspection·April 29, 2025

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct an annual inspection. LPA Moleski spoke with facility administrator Lani Calagui over the phone and explained the purpose of the visit. Upon entry, LPA Moleski observed a caregiver working in the facility (S1). LPA Moleski reviewed Guardian records and observed that S1 was not associated to this facility's roster. S1 said they had been working at this facility for nearly three months. LPA Moleski reviewed five resident files (R1-R5) and three staff files (S1-S3). S2 had no personnel record (LIC 501) on file, and also had no first aid/CPR certification on file. S3 had no health screening or tuberculosis test results on file. Two residents (R4 & R5) did not have appraisals on file which were conducted within the last year. R4's most recent appraisal on file was dated 07/26/2019 and R5's most recent appraisal on file was dated 02/24/2024. As of January 1, 2025, reappraisals must be conducted at least once per year for all residents, regardless of diagnosis, per 22 CCR Section 87463(a). LPA Moleski toured the facility with staff and inspected common areas, the kitchen, bedrooms, bathrooms, and backyard areas. Furniture and furnishings were sufficient to meet the needs of residents. The facility temperature was 73 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's water temperature measured 110 degrees Fahrenheit, which is within the required range of 105 and 120 degrees. [continued on 9099-C] LPA Moleski observed first aid supplies, a fully-charged and up-to-date fire extinguisher, and carbon monoxide/smoke detectors. LPA Moleski observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA Moleski observed a locked cabinet for the storage of medication. LPA Moleski observed locked cabinets for the storage of cleaning solutions and knives. LPA Moleski asked for documentation of emergency disaster drills. Calagui was not sure where these were kept. LPA Moleski was provided the facility's emergency disaster plan, which did not include drill records, but did include the following statement, dated March 1, 2015: "Fire drills will be held monthly with the facility residents as part of our ongoing goal to keep the facility safe." HSC Section 1569.695(c) requires emergency disaster drills to be documented at least once per quarter, however, per 22 CCR 87208(a), "The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so." This facility is hereby cited per 22 CCR Sections 87355(e), 87412(a), 87506(b)(17)(E), and HSC Section 1569.695(c). Due to a violation of criminal record clearance requirements, a $500 civil penalty is hereby assessed. An exit interview was held with Calagui. Appeal rights and a copy of this report were emailed to Calagui for her to sign.