Routine inspection·September 13, 2024

At approximately 9:40 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and was greeted Staff 1 (S1) and Staff 2 (S2). Kristine Lorenzo, House Manager/Designated Responsible Party (RP) was contacted and arrived at approximately 10:05 AM. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6 ) residents in care. LPA was informed that Resident 1 (R1) and Resident (2) were away at Day Program and the remaining four (4) residents were present during today's visit. Facility has a hospice waiver for two (2), a bedridden waiver for one (1), is approved for all non-ambulatory residents, and is vendorized with North Bay Regional Center (NBRC). At approximately 10:30 AM, LPA initiated a tour of the facility with RP and observed the following: Facility is a two story home, was a comfortable temperature, and passageways were free from obstructions. Licensee stopped by at approximately 11:15 AM and ordered the facility an evacuation chair. Water temperatures in clients' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens and paper products available to clients. Clients' bedrooms were inspected and observed to have appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA advised House Manager and Licensee to ensure all such items are secured and inaccessible to residents when not being used. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. There is a covered seating area in the backyard with outdoor space for activities. LPA observed an activity schedule and was informed that each NBRC client has their own internet access device and the facility has an additional device available for resident use. Facility has internet available to clients in care and the phone was tested an operational. Facility's fire extinguisher was observed charged and was last serviced July 2024. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Continued on LIC809-C... Continued from LIC809... Facility conducts regular monthly disaster drills, and the most recent drill was conducted September 2024. LPA observed facility's infection control plan and emergency disaster plan which was last updated January 2024. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights for emergency preparedness. RP states the facility has a backup solar battery if needed. At approximately 12:00 PM, LPA reviewed five (5) staff files and six (6) resident files. Five (5) of five (5) staff files reviewed have the required paperwork and proof of current First Aid and CPR training. However, six (6) of six (6) staff were short one hour of medication training. (See LIC809D). Five (5) of five (5) resident files reviewed have all the required paperwork. RP coordinates medical and dental visits for the clients and take them to their appointments. At approximately 3:00 PM, LPA reviewed medications and medication records which are maintained and stored in compliance with regulation. However, LPA observed 7/9 instances where staff did not follow the physician's order and instructions for the proper administration of a medication for Resident 3 (R3). (See LIC809D). LPA reviewed P&I monies and logs, which were organized, maintained, and stored according to regulation. RP informed LPA that the Licensee has appointed them as the new facility Administrator. LPA discussed the process and the documents that need to be submitted to CCL to make the change official with Licensing. Required Change of Administrator Documents: LIC 308 (Designation of Facility Responsibility) Active and Current Administrator Certificate First Aid Certificate LIC 500 (Personnel Report) Continued on LIC809C... Continued from LIC809C... LIC 501 (Personnel Record) LIC 503 (Health Screening Report - personnel) Proof of Negative TB test LIC 9182 (Criminal Record Exemption Transfer Request) LIC 508 (Criminal Record Statement) Copy of Driver's License or Passport that is not expired Copy of Board of Directors' Resolution meeting minutes signed (required for all corporations) Updated copies of the following documents are to be submitted to CCL within 30 days of this visit : LIC500 - Personnel Report (updated) Copy of New Liability Insurance Policy Copy of New Facility Lease 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 RP and Appeal rights were given. Signature on form confirms receipt.