Routine inspection·February 7, 2024

On, 2/7/2024, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. inspection visit for this facility and was greeted by Administrator, Elmar Mallare. The facility is licensed for 4 non-ambulatory residents and a hospice waiver for a capacity of 2. The facility currently provides care for four residents, none of which are receiving hospice services and none of which have a diagnosis of dementia. LPA continued with a tour of the facility with Administrator, facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility exits were properly equipped with auditory alarms tested and found to be in working order. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be inspected and charged. Both smoke detectors and carbon monoxide detectors throughout the facility, tested and found to be in working order. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations with food properly stored and labeled. Toxins, sharps and other items that could pose threat if readily available to residents were kept secured in the kitchen, laundry room and garage. Residents were observed engaging in discussion with staff in common areas and watching television in their bedrooms. Residents appear to have a positive relationship with staff based on LPA observations. LPA was informed that the facility partners with an outside recreation therapist that provides supplies for painting and crafts. Residents also participate in personal leisure activities including puzzles and television in their bedrooms and common areas. LPA observed resident bedroom equipped with a half railing hospital bed. Facility has clearly posted the physician's order for the use. LPA toured the backyard and found two emergency exits on each side of the home to be unobstructed. Continued onto LIC809-C There was a supply of hygiene products, continence products, paper products and clean linens available for residents. All resident bedrooms have lighting & appropriate furnishings. Medications are stored in a designated medication cabinet located in the dinning area and were found to be secured. LPA conducted spot medication count and found all prescription medication to be properly recorded on the Centrally Stored Medication Record. The Administrator conducts audits for medication on a monthly basis. The facility utilizes a combined Centrally Stored Medication Record and Medication Administration Record in one document and found to be in order. A sample file review for staff was conducted and LPA found all staff to have sufficient 1st Aid & CPR certification and annual training on file. LPA also conducted a file review for all residents and found all physician's reports and needs and services plans to be up to date. In addition, all residents and vendorized under North Bay Regional Center with all Individual Program Plans updated. Administrator Elmar Mallare's Administrator Certificate is valid through 8/15/2025 and found to be posted clearly near the front of the facility. LPA requested the following documents be sent to CCL by COB 2/21/2024: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Liability Insurance Control of Property No deficiencies cited during today's visit