Routine inspection·July 31, 2024

Licensing Program Analysts (LPAs) Vincent Moleski and Holly Williams arrived unannounced to conduct an annual inspection. LPA Moleski met with facility administrator Jennell Revera and explained the purpose of the visit. LPAs Moleski and Williams reviewed 10 resident files (R1-R10) and five staff files (S1-S5). R1's latest LIC 602 on file was dated 6/15/22. R1 was diagnosed with dementia, according to the LIC 602. R2 was seen by their physician on 2/28/23, according to their most recent LIC 602. R2 has dementia, according to the LIC 602. LPA Moleski reviewed a staff roster and Guardian records. LPA Moleski observed that S6 was separated from this facility in January 2024. According to Revera, S6 has continued to work at this facility from April to present, but has not been re-associated. Another employee, S12, had not been fingerprinted. However, S12 is under the age of 18 and therefore does not need to be fingerprinted. 22 CCR Section 87411(b) states that staff members who " supervise or care for residents " must be at least 18 years of age. LPA Moleski reviewed S12's job description and did not observe any duties relating to care and supervision of residents. LPA Moleski toured the facility with Revera and inspected common areas, the kitchen, bedrooms, bathrooms, and outdoor areas. Furniture and furnishings were sufficient to meet the needs of residents. The facility temperature was 72 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's water temperature measured 113 degrees Fahrenheit, which is within the required range of 105 and 120 degrees. [continued on 809-C] LPA Moleski observed first aid supplies and fully-charged fire extinguishers. LPA Moleski observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA Moleski observed locked cabinets for the storage of cleaning solutions. LPA Moleski interviewed five staff members (S7-S11) and five residents (R11-R15). This facility is being cited per 22 CCR Sections 87355(e)(3) and 87705(c)(5). A civil penalty in the amount of $500 for a total of five days worked by S6 was assessed. An exit interview was held with Revera. Appeal rights and a copy of this report were left with Revera. This report was amended on 8/2/24. LPA Moleski had previously erroneously stated in this report that S12 and other under-18 employees must be fingerprinted, which is not correct. Civil penalties regarding S12 will not be assessed, and an updated copy of the civil penalty assessment will be provided to the licensee at a later date.