Routine inspection·July 23, 2024

On 07/23/2024, Licensing Program Analyst (LPA) Jaime Vado and Kiran Jain conducted an unannounced annual inspection visit. LPA met with caregiver Lee Collano initially, then around 0915 the administrator/licensee Alex Zitser arrived, and LPA explained the purpose of today's visit. LPAs was allowed entry into the facility. This is a split level facility approved all residents to be non-amblatory and 2 hospice residents. The physical plant was toured inside and outside of the facility to ensure the safety of the residents. LPA observed the facility kitchen which is clean and observed appliances are in good repair. Knives are stored and locked in the kitchen in a drawer adjacent to the facility stove. Medications are observed to be locked in a cabinet adjacent to the refrigerator. Perishable and non-perishable food items are observed as in place. There are additional refrigerator and freezer in the garage area which also carry additional food supplies. First aid kit i s observed as complete with required items. LPA observed that there are multiple fire extinguishers in place inspected 08/25/2019 but it is charged within the normal operating range, smoke detectors, carbon monoxide detectors are observed in place through out the facility, facility is equipped with full fire sprinklers through out, and central heating/cooling system. Facility is also equipped with fire alarm pull station near the front door. PPE and additional food supplies are observed as in place. Laundry area is also observed as fully operational in the garage area. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Last emergency/disaster drill is not documented nor conducted for at least a year which poses an immediate health and safety risk for residents in care. Water temperature was measured at 133F in a common resident bathroom in the hallway connecting to resident rooms on the upper floor. This temperature poses an immediate health and safety risk to residents in care. Also observed in place in common areas are video cameras for resident safety. Continued on next page... Page 2 LPAs observed rooms numerous resident rooms and all appeared clean, free of odors, and contained all the required furniture per regulatory recommendations. Resident linen supplies are observed as in place in linen closet on the upper level. Cleaning supplies are observed in the upper floor bathroom below the sink, this poses an immediate health and safety risk to residents. Facility does not handle resident monies. During today's visit LPAs reviewed three resident files and 3 staff files. Per file reviews, staff files were not current with first aid cards or CPR cards. This poses an immediate health and safety risk to residents in care. The following updated forms are requested to be submitted to CCLD by 07/30/2024 : • Copy of updated Administrator Certificates • Copy of facility's liability insurance • LIC308 Designation of responsible staff person • LIC610E Emergency Disaster Plan • LIC500 Staff Schedule • Copy of control of property or current lease Citations are issued on this day on the attached LIC809D pages. Report is reviewed with the licensee/administrator Alex Zitser and a copy is provided on this day.