Routine inspection·November 18, 2024

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by Licensee Clayton Anderson. LPA and licensee toured the building and grounds. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered. Freezer located in the garage needs to be cleaned out and all expired items removed. Kitchen cabinet containing cleaning supplies was locked. Kitchen drawer with sharp knives locked. All bedrooms were equipped with lighting, night stand, and chest of drawers. Dead insects found in the window sill of rooms #1 and #2. Resident bathroom had required bath mat and grab bar. Water temperature in sink accessible to residents in care measured at 109.3 and 112.5 degrees F which is within the allowable range of 105 to 120 degrees F. Upon LPA arrival to facility, passageway was blocked due to multiple walkers being present ( deficiency cited, see 809D ). LPA discussed with licensee providing activities for the residents that meet regulation. Currently, the facility does not offer an activity program that addresses the needs and limitations of residents with dementia which include large motor activities and perceptual and sensory stimulation ( deficiency cited, see 809D ). Additionally, LPA and licensee discussed activities and providing room enough in the facility for activities and visitation. There are six [6] residents and [4] possible seats to sit in. The only indoor area accessible to residents for activities and for recreation is the small dining area occupied by dining table with chairs, one small love seat, and 3 recliners. LPA discussed with licensee providing sufficient space for residents to use for activities and leisure. The facility's Living room is currently occupied by licensee's alleged non-resident client and being used as a bedroom. LPA and licensee discussed making living room accessible to residents in order to maintain compliance with regulation ( deficiency cited, see 809D ). Continued on 809C... Continued from 809... Fire extinguishers were last inspected 8/27/24. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drills were conducted 10/30/2024. Emergency fire exit path on right facing side of the facility is blocked by multiple items ( deficiency cited, see 809D). Ramp on deck leading to grass has a soft spot and is broken/worn through. Tree House and ladder on tree in backyard is not secured, must be made inaccessible to residents ( deficiency cited, see 809D ). LPA conducted a review of six [6] resident records. R1 and R2 do not have current appraisals ( deficiency cited, see 809D ). LPA conducted review of five [5] staff records. S1, S2 did not have current 1st Aid/CPR ( deficiency cited, see 809D ). LPA reviewed training materials used for staff training. Medications training is conducted using a manual from 2001 and other topics on burned CD discs dated 2015. Licensee to either use an approved vendor for training or submit updated training materials to CCL for approval no later than 12/2/2024. LPA conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. Chey Ilan Administrator Certificate 7005493740 has expired but renewal is pending as of 5/3/2024. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report Liability Insurance Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Licensee. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with licensee and a copy of this report was given .