Routine inspection·November 18, 2022

Licensing Program Analyst (LPA) Erik Gonzalez Campos arrived unannounced on 11/18/2022 to conduct a Required - 1 Year inspection. LPA met with administrator, Chey Ilan and licensee, Clayton Anderson. This inspection is focused on the infection control practices and procedures of this facility. LPA toured facility with administrator. Facility has 3 shared bedrooms. Building and grounds were clean and in good repair. Exits and walkways were clear from obstructions. Facility is renovating deck and is currently not available for resident use. Santa Rosa Fire department performed an inspection of the facility on 11/14/2022. Fire extinguishers were charged and current. Carbon monoxide and smoke detectors were present and operational throughout the facility. Facility is currently conducting screening of visitors at the front entrance. LPA observed sufficient perishable and non-perishable food in the kitchen. Toxins were secured and inaccessible to residents in care. Medications were locked and inaccessible to residents in care. LPA and administrator discussed resident record keeping, including but not limited to LIC 602s, initial appraisals, reassessments, needs/services plans, and medication lists. LPA provided list of training required for staff annually. LPA and administrator discussed CPR/First Aid requirements. LPA is requesting the following documents be submitted to Community Care Licensing within 30 days of today's inspection: LIC 500 Personnel Report LIC 9020 Resident Roster LIC 308 Designation of Facility Responsibility LIC 610 Emergency Disaster Plan Evidence of Liability Insurance No deficiencies cited during today's inspection. Exit interview conducted with administrator.