Routine inspection·October 2, 2024

On 10/02/2024, Licensing Program Analyst (LPA) Vado Jaime Vado conducted an unannounced annual required inspection visit. LPA met with caregivers initially then later during the visit the licensee/administrator Nancy Castle arrived to meet with LPA. There are currently 6 residents in the facility during today's visit and 3 staff present. This is a multi-level facility licensed for residents age range of 60 years and over all of which may be non-ambulatory. License is approved for 4 hospice residents. Residents do not reside on the upper floor as that floor is for staff only. The physical plant was toured inside and outside of the facility to ensure the safety of the residents. There are cameras posted around the outside of the facility and in common areas inside the facility such as the dining room, hallway, and other areas. LPA observed the facility kitchen which is clean and observed appliances that are in good repair. Knives are stored and locked in a cabinet next to the stove. Perishable and non-perishable food supplies are in place. There are additional refrigerators in the garage area which carries additional food supplies for resident use. First aid kit is observed as complete with required items stored in the kitchen of the facility. Medications are observed to be locked in a cabinet in the dining room. LPA observed at least two fire extinguishers in place which are currently within operating range, smoke detector, carbon monoxide detectors are observed in place through out the facility, and central heating. PPE is observed to be in place. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Last emergency/disaster drill was conducted 04/10/2024. Technical violation is discussed regarding conducting such drills quarterly. Water temperature was measured at 105F. Cleaning supplies are observed to be locked in the garage. Continued on next... Page 2 LPA observed all resident rooms as clean, free of odors, and contained all the required furniture per regulatory recommendations. Resident bathrooms are observed as clean and in good worker order. Shower floors are equipped with non-skid mats or flooring. Facility does not handle resident monies. Medications and logs are observed today as current. During today's inspection LPA reviewed 5 resident files. 2 resident files did not have current physician reports for R2 and R3 both of whom have a diagnosis of dementia Resident with dementia require an annual physicians report. This poses an immediate health and safety risk.. Also, residents only had preplacement appraisals on file but no needs and service plans. LPA advised on having appraisal needs and service plans on file via technical assistance. 3 staff files are also reviewed as current. Administrator certificate is observed as current expiring 04/04/2026 per certificate observed on site. The following updated forms are requested to be submitted to CCLD by 10/09/2024 : • Copy of all updated administrator certificate • Copy of staff first aid cards • Copy of facility's liability insurance • Copy of facility resident roster • LIC308 Designation of responsible staff person • LIC610E Emergency Disaster Plan • LIC500 Staff Schedule • Copy of control of property or copy of lease Citations are issued on the following LIC809D. Technical violation is discussed on the following LIC9102TV and LIC9102TA. Report is reviewed with co-administrator Armand Atienza.