Routine inspection·June 28, 2021

Licensing Program Analysts (LPA) Fernandes-Goes conducted an unannounced Annual Required – 1 yr. Infection Control inspection to this facility and was welcomed by Doug Cattich – Licensee/Administrator. There were 8 residents present at the facility. LPA arrived at the facility and had temperature checked. All staff temperatures checked and logged each shift. Staff placed their masks once LPA arrived. LPA toured the facility with Doug Cattich Licensee/Administrator. During tour on 6/28/2021 facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers were found to be last charged on 2/2021 at the time of the visit. A sample of 4 out of 4 Smoke Detectors & Carbon monoxide detectors were found to be operational during the visit. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Facility staff understands that food stored in the kitchen refrigerator must be properly stored as per regulations. Hot water temperature measured between 105.0 degrees F and 113.1 degrees F within acceptable regulations of 105 to 120 degrees F in 2 of 2 client’s bathroom faucets. There was a supply of cleaners, hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings. Infection Control: Facility has submitted a mitigation program plan that has been approved. Posters have been placed at facility. Facility has PPE supply stored in one of the residents'’ bathroom. Residents’ medications are stored and locked in the kitchen cabinet. Facility has a 30-day supply of medication for residents. Residents do not wear masks inside the facility. Continue LIC 809-C In addition, facility has a designated area for visitors in the front porch and/or in the bedrooms when possible. Visits are been scheduled. Residents have also available telephone calls when contacting with family members and others. Staff had all PPE training required on file and still working towards acquiring N-95 fit testing. LPA reviewed Licensing Information System (LIS) with licensee who stated that is corrected and updated at this time. In addition, LPA advised facility to contact County Public Health and DSS/CCL Community Care Licensing immediately if symptoms or COVID-19 + in the facility. There were no deficiencies cited at this time. Department is requesting the following to be submitted to RO Rohnert Park by July 5 th , 2021 as follows: LIC 308 Designation of Facility Responsibility LIC 500 Personnel Report Copy of Liability Insurance Copy of Administrator Certificate