Routine inspection·June 6, 2024

At approximately 8:30AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1-Year Required Visit and met with Staff Member, Mariana Sanchez. Designated Representative, Guadalupe Rivera, arrived during visit at approximately 9:00AM. Licensee, Christine Woltering, arrived during visit at approximately 1:40PM. Facility serves older adults and has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance and total capacity for 6 non-ambulatory residents of which 1 resident can be bedridden. Facility has an approved hospice waiver for 1 individual. Upon arrival, LPA was informed that there were 5 Residents in care and 2 staff members on-site. At approximately 8:45AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. LPA also observed that the significant other of a staff member lived on-site. Review of Facility's Staff Roster indicated that this individual was not on the Facility's Staff Roster. Per conversation with facility staff, this individual does not provide direct care to the residents. LPA confirmed on the Guardian website that this individual was background cleared but not associated to the facility as required. LPA observed individual be associated during visit. ** Administrator understands that a civil penalty is not being issued today for individual because they were associated to the facility during visit.** At approximately 9:35AM, LPA conducted a walk-though of the facility with Designated Representative. Per Facility sketch, facility is a one story building with 6 bedrooms, 3 bathrooms, and common spaces. During visit, LPA observed a granny unit on-site that was not indicated on the facility sketch. LPA and Designated Representative discussed submitting an updated facility sketch (see Technical Violation, LIC9102, Regulation 87208(a)(7)(A) ) . Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility has an Infection Control plan on file. Continued on LIC809C Continued from LIC809 There was a sufficient supply of perishable foods as required by Title 22 Regulations. LPA and Designated Representative discussed having at least 7 days of non-perishable foods available for residents (see LIC9102, Technical Advisory, regulation 87555(b)(26)). There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Mattress pads were in place or available for Resident use. Hot water temperatures for all sinks were found to be out of compliance with Title 22 Regulations, measuring at 126.6F, 129.7F, 129.0F, 131.3F, 130.6F, and 131.9F (this deficiency has been cited, see LIC809D, Regulation 87303(e)(2)). Facility's fire extinguishers were last inspected April 2024. Facility's last emergency/disaster drill was conducted May 2024. At approximately 11:15AM, LPA reviewed staff files and resident files. Staff Files were found to be well organized, thorough and contained the required documentation. Staff files had current First Aid and CPR certification. During Resident File Review, LPA observed that 1 of 5 residents did not have an updated annual Physician's Report as required for individuals with dementia (this deficiency has been cited, See LIC809D, Regulation 87705(c)(5)). LPA conducted interviews. Administrator's Certificate for Christine Woltering (6033992740) was current with an expiration date of 02/25/2025. Administrator's Certificate for Zoe Wildgust (7020635740) was current with an expiration date of 10/10/2025. LPA unable to complete Annual Inspection. Annual Continuation Visit to be conducted at a later date. 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. Copy of report, LIC-809D (Deficiency Page), LIC9102 (Technical Advisory/Violation), LIC811 (Confidential Names), Plan of Corrections, and Appeal Rights discussed and provided to Designated Representative. Signature on form confirms receipt of documents.