Routine inspection·June 12, 2024

At approximately 1:40 PM on 06/12/2024, Licensing Program Analyst (LPA) Stefanie Mutialu made an unannounced annual required inspection of this licensed senior care facility. LPA was greeted by caregiver, Mildred Mamaradlo, Caregiver. Administrator, Donnabell is out of the country. The facility is a single story home licensed for six (6) non-ambulatory residents and hospice waiver capacity of two (2). The facility currently provides care for six (6) residents. Six out of six residents were at home and six out of six residents were eating or watching television for leisure. In addition, there are six (6) residents with a diagnosis of dementia and one resident on hospice. At approximately 2:00 PM, LPA and caregiver toured the building and grounds which was found to be clean and in good repair. All notices that are required to be posted have been posted and are in a highly visible area. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Toxins are stored in a locked cabinet in the facility laundry room and kitchen .LPA observed insect killer in backyard accessible to residents. Sharps and other kitchen supplies that could pose danger if available to residents were found secured in the kitchen cabinet. There was a supply of cleaners, hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings. Water temperature measured within regulation between 111 and 114 degrees F at six of six faucets accessible to residents. One of One Fire extinguisher inspected was charged. Four of four Smoke detectors and One of one Carbon Monoxide detector was present and inspected. Disaster Drills are conducted quarterly with the last drill conducted 06/2024. There was enough lighting in all common areas, resident rooms, and hallways. LPA to continue annual at a later date. Continued on 809C Continued from 809 At approximately 4:00 PM on 06/28/2024 , Licensing Program Analyst (LPA) Stefanie Mutialu made an unannounced annual continuation required inspection of this licensed senior care facility. LPA was greeted by caregiver, Mildred Mamaradlo,( MM) provided LPA with Client and staff files. Administrator, Donabell Saddi arrived shortly after. At approximately 04:15 PM, LPA reviewed 6 of 6 Client records which were all found to be well organized , thorough, and contained the required documentation. LPA reviewed 4 of 4 Staff records, which were all found to be well organized but did not contain the required documentation, 4 of 4 staff files missing LIC501 and 2 of 2 staff records are missing LIC503-Medical Assessment and TB screening. Administrator to provide to CCLD, LPA advised Administrator all staff records must be kept at facility at all times. First aid and CPR certification were current in staff files reviewed. Administrator's Certificate is expired as of 04/28/2024 and pending per documentation provided from CDSS CCLD website. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility LIC610D- Disaster Plan (updated with non-local evacuation site) Resident Roster LIC501 LIC503/TB Screening Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Civil Penalties assessed . Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in further civil penalty assessment. Appeal rights were given on 06/12/2024