Routine inspection·October 17, 2024

At approximately 12:00 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and was greeted by Anny Camerino, Licensee/Administrator. Facility is a Residential Care Facility for the Elderly (RCFE) with three (3) residents in care. All residents were present during today's inspection. Facility is vendorized with the North Bay Regional Center (NBRC). At approximately 12:20 PM, LPA initiated a tour of the facility with Licensee 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. LPA observed a supply of clean linens, paper products, and incontinent care briefs available to residents. Residents' 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. Facility has at least two days of perishable food and one week of non-perishable foods. LPA observed 5 instances of expired food (See LIC809D). LPA advised Licensee to maintain an emergency water supply as well. Medications were centrally stored and locked. There is a covered seating area in the backyard with outdoor space for activities. Licensee states that each resident has their own internet access device. Facility has internet available to residents in care and the phone was tested an operational. Facility's fire extinguisher was observed charged and was last serviced 08/2024. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Facility conducts quarterly disaster drills with the most recent drill was conducted 09/2024. Continued on LIC809-C... Continued from LIC809... LPA observed facility's infection control plan and emergency disaster plan which was last updated 12/2022. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights for emergency preparedness. Licensee provided LPA with a copy of the facility's current liability insurance. At approximately 1:20 PM, LPA reviewed three (3) staff files and three (3) resident files. Three (3) of three (3) staff files reviewed were missing required documentation; Staff 1 (S1) was missing proof of negative TB results; Staff 2 (S2) was missing proof of a health screening and negative TB results; and Staff 3 (S3) was missing a personnel application and proof of a health screening and negative TB results (See LIC809D). All staff have proof of current First Aid and CPR training. Licensee was unable to provide proof of the required initial 40 hours of staff training for all staff as well as completion of the required initial medication training for all staff (See LIC809D). LPA advised Licensee to ensure compliance with and proof of all staff initial, annual, and medication training and that all are available for review by Licensing upon request. LPA provided Licensee Health and Safety Code (HSC) regulations 1569.625 and 1569.69 for reference. Three (3) of three (3) resident files reviewed were missing the required LIC625 Appraisal and Needs Service Plan (See LIC809D). Licensee/Administrator coordinates medical and dental visits for the residents and takes them to their appointments. At approximately 5:30 PM, LPA reviewed medications and medication records which are stored in compliance with regulation, However, LPA observed that the centrally stored and destruction medication logs for R1, R2, and R3 were not maintained in compliance with regulation (See LIC809D). Facility does not manage P&I monies. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit : LIC500 - Personnel Report (updated) LIC610E - Emergency and Disaster Plan (updated) LIC9020 - Resident Roster 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. Appeal rights were given. Exit interview conducted with Licensee whose signature on form confirms receipt.