Routine inspection·December 19, 2024

At approximately 11:00 AM, Licensing Program Analysts (LPAs) Julie Florio and Robert Frank arrived unannounced to conduct a required 1-year annual inspection and were greeted by Jasmine Aliscad, Administrator. Facility is a Residential Care Facility for the Elderly (RCFE) with four (4) residents in care. Residents 2 (R2), Resident 3 (R3) and Resident 4 (R4) were present during inspection and LPAs were informed that Resident 1 (R1) was away at their day program. Facility has a Dementia Care Plan, is approved for all non-ambulatory residents, and is vendorized with North Bay Regional Center (NBRC). At approximately 11:45 AM, LPAs initiated a tour of the facility with Administrator and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPAs observed a supply of clean linens, and hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. However, LPAs observed the key used to unlock said cabinets hanging on a hook in the kitchen where accessible to residents in care, (see LIC809D). Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency Food and water supply. Medications were centrally stored and locked. There is a shaded seating area in the backyard with outdoor space for activities. LPAs observed 1 locked shed in the backyard which LPAs inspected and observed the contents to consist of PPE supplies, extra resident care equipment, holiday decorations, and an emergency generator. LPAs observed an activity schedule and were informed that the residents play bingo, go bowling, watch movies, and engage in sensory activities. Facility also hosts holiday parties for the residents and throws a large Halloween, Thanksgiving, Christmas, and 4th of July party in a central location where all five (5) care homes attend. Facility has internet access and provides a designated internet access device for resident use. Facility has a telephone which was tested during inspection. Continued on LIC809-C... Continued from LIC809C... Facility's fire extinguisher was observed charged and was last serviced 10/2024. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Centralized Fire system was tested and all fire doors closed automatically. Facility conducts monthly disaster drills, and the most recent drill was conducted 12/2024. LPAs observed the facility's infection control plan, first aid kit, PPE, and emergency supplies. LPAs reviewed facility's emergency disaster plan last updated 1/2024. At approximately 12:45 PM, LPAs conducted file review. Four (4) staff files and four (4) resident files were reviewed. All staff files reviewed have all of the required paperwork including the required CPR and First Aid training certificates and documentation of all required initial and annual training hours. Four (4) of four (4) resident files reviewed contained all the required documentation per regulation. Administrator states they coordinate residents' medical and dental appointments and transportation to and from visits. Medications and P&I were reviewed and observed managed and maintained within regulation. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit : LIC500 - Personnel Report (updated) LIC610D Emergency Disaster Plan (updated) Proof of Liability Insurance (updated) Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted with Administrator and Appeal rights were given. Signature on form confirms receipt.