Routine inspection·August 15, 2024

Licensing Program Analysts (LPAs) Christi Coppo and Marisol Cuadra arrived unannounced to conduct a required Annual inspection and was greeted by caregiver. Administrator Lily Alcones arrived later. Facility contact information was reviewed. At approximately 9:15am LPAs toured the building and grounds. The facility was found to be at a comfortable temperature. LPAs 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. Kitchen drawer with sharp knives locked. Cabinets containing cleaning supplies locked. All bedrooms were equipped with lighting, night stand, and chest of drawers. Extra hygiene products and linens were available. Resident bathroom had required bath mat and grab bar. Water temperature in sink accessible to residents in care measured at 158 degrees F in the kitchen, LPA could not get a hot water reading in the bathroom across from room six, the water never got hot after running the water for 4 minutes which is not within the allowable range of 105 to 120 degrees F ( deficiency cited, see 809D ). LPAs observed window in back bathroom in hallway to be broken, does not stay up when lifted, will not stay open. LPAs observed hole in wall on left side of the refrigerator. Backyard deck in disrepair, handrails broken and base of handrails cracked. Fence in backyard also in disrepair. Planks separated from fence with nails exposed. Large fence surrounding the perimeter of the facility is also in disrepair, boards separating from fence and nails exposed. Vents on side of house have gaps and black film substance. Per LPAs conversation with Admin they agree to repair. LPAs reviewed fire clearance facility sketch and observed exit gate to be identified as an emergency exit. LPAs observed exit gate to be broken, does not close or open all the way. However, because this is identified as a fire clearance exit, it must offer access for residents as an escape in emergency situations. ( deficiency cited, see 809D ). Continued on 809C... Continued from 809... LPAs discussed with Admin deck and kitchen, Admin indicated that they will be redoing the deck and remodeling the kitchen, but not changing the structure of the facility. LPAs advised that if they do change the structure of the facility they must obtain the proper and required permits first and give notice to CCL prior to any initiation of construction. Fire extinguishers were last inspected 9/15/2023. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drills were conducted on 6/27/2024. Facility has a backup generator for use during a power outage. At approximately 10:30am LPAs conducted review of 5 staff records. All required documentation present. Admin indicated they have three full time staff, one of which is staff (S1). However, (S1) did not have fingerprint clearance and not associated to the facility, but per Admin has been working here for about 3 months ( deficiency cited, see 809D and civil penalty assessed in the amount of $500 LIC421BG ). At approximately 11:30am LPAs conducted a review of 6 resident records. Resident (R1) is indicated as bedridden on their physician's report. However, facility does not have fire clearance for bedridden residents. Admin unable to produce proof of notification to the Santa Rosa Fire Dept. LPAs and Admin discussed bedridden status on current physician's report, due to two different status being marked, Admin agreed to get updated physician's report clarifying ambulatory status of resident R1 ( deficiency cited, see 809D ). At approximately 12:00pm LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. No deficiencies Lily Alcones Administrator Certificate 7003673740 expires 8/31/2024. All fees are current as of this time. LPAs and Administrator discussed facility's Infection Control Plan and Emergency Disaster plan. No new updates. Continued on 809C(2)... Continued from 809C... 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 LIC308- Designation of Responsibility 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 Administrator and a copy of this report was given