Routine inspection·June 20, 2024

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by caregiver. Administrator Isabel Melanson arrived later at approximately 10:00am. Facility contact information was reviewed. At approximately 9:30am LPA and caregiver toured the building and grounds. Admin joined tour at approximately 10:00am. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. The following observations were made of food stored in pantry: tomatoes in bin had black spots, white film, and bluish greenish fuzzy film surrounded by white substance. Storage bin containing canned good had sticky brown film and brown substance with orange film on some cans. Open ziploc bag of lentils, lentils spiling out into bin. Macaroni and cheese box with best when used by date of 3/20/2023 ( deficiency cited, see 809D ). Kitchen had block of knives open and accessible when half door to kitchen is left open. LPA observed on three occasions during inspection that half door to kitchen was left unlocked, making knives accessible to residents in care ( deficiency cited, see 809D ). Per LPA conversation with Admin, Admin to move sharp knives to locked drawer. LPA and caregiver observed broken cabinet lock in long hall laundry room, cabinet contained toxins and cleaning supplies . Admin advised LPA that the broken lock is scheduled to be replaced by repairman and laundry room door remains locked at all times. All bedrooms were equipped with lighting, night stand, and chest of drawers. However, R1 in room #10 did not have bed present. R1's pre-appraisal, care plan, and physician's report did not note a preference or an approval for not having a bed ( deficiency cited, see 809D ). All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Resident bathrooms had required bath mat and grab bars. Water temperature in sinks accessible to residents in care measured at 121.3 degrees F in long hall bathroom (next to room #6), 119.3 degrees F in room #12, 118.7 degrees F in room #11, 118.5 degrees F in room #10, 114.7 degrees F in room #3, and 117.4 in the main bathroom, degrees F all which are within the allowable range of 105 to 120 degrees F except for in the bathroom next to room #6. Admin turned down water heater slightly to bring temperature down to below 120 degrees F. Continued on 809C... Continued from 809... Four [4] out of [4] fire extinguishers were last inspected 12/7/2023. Smoke/Carbon Monoxide detectors located throughout the facility are serviced by vendor, last serviced 2/19/2024. Per Admin, fire disaster drill conducted last month . However, no documentation of drill conducted was available. LPA confirmed with staff that fire drill was conducted. Admin will keep record of drill documentation going forward. Facility has a backup generator for use during a power outage. At approximately 11:30am LPA conducted review of 5 staff records. S1, S2, and S3 do not have current 1st Aid/CPR certifications on file ( deficiency cited, see 809D ). S4 did not have TB clearance on file ( deficiency cited, see 809D ). S2, S3, and S5 did not have current annual training ( deficiency cited, see 809D ). At approximately 1:30pm LPA conducted a review of 5 resident records. All required documentation present. At approximately 2:30pm LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. No deficiencies Isabel Melanson Administrator Certificate 7024381740 expires 2/8/2025. LPA and Administrator discussed facility's Infection Control Plan and Emergency Disaster plan. No new updates. 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 Admin. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator and a copy of this report was given