Routine inspection·March 28, 2024

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 3/28/24 at approximately 12:40pm, and met with Licensee/Administrator Mera Shaughnessey. There currently are five (5) residents in care. Facility has an approved dementia plan of operation. There is an approved hospice waiver for three(3)residents. Facility has a required infection control plan. Facility has an emergency and disaster plan as required. The facility conducted a fire drill and earthquake drill on 1/5/24. Facility does have a generator for emergencies if needed. The facility does have emergency food, water, and supplies to meet the "72 hour shelter in place" requirements. LPA reviewed five (5) resident files. All files were complete. The LPA reviewed five (5) staff files. All staff have criminal record clearance. All staff have current first aid and CPR certification as required. The LPA toured the facility with the Administrator Mera. The hot water was checked at 117. degrees Fahrenheit , which is within regulation. The fire extinguishers were tagged and serviced as required-expires 12/28/24. All exits were unobstructed. Food supply was sufficient. All bathrooms have grab bars, and the large shower room and private shower bathrooms have mats for resident use. The facility is well lighted, including all resident rooms and bathrooms. The facility was observed to be warm and at a comfortable temperature. Cleaners/toxins were locked and inaccessible to residents in care. All medications were locked up and not accessible to residents in care. Facility had sufficient furnishings for client use. Continued on LIC809C.. LPA is requesting the following documents be updated and submitted by 4/28/24. LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to review and update as needed/required) Infection Control Plan (ensure to review and update as needed/required) Copy of LIC400 Handling of Client Cash Resources (include copy of surety bond if handling cash) Copy of Current Liability Insurance Resident Roster Copy of current Administrator Certificate . The following deficiencies were observed during staff file reviews: Four (4) out of five (5) staff lacked annual required training hours, per LPA's file reviews. This deficiency will be cited, HSC 1569.696(b)(2) 2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training, see LIC809D. Four (4) out of five (5) staff lacked required Health and Safety Code annual medication training, per LPA's file reviews. This deficiency will be cited, 1569.69(b)Each employee who received training and passed the examination required in paragraph (5) of subdivision (a), and who continues to assist with the self-administration of medicines, shall also complete eight hours of in-service training on medication-related issues in each succeeding 12-month period, see LIC809D. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator/Licensee Mera Shaughnessey. Appeal Rights provided to the Administrator.