Routine inspection·April 24, 2025

Licensing Program Analyst (LPA) Alviso, arrived unannounced to conducted a Required -1 Year visit, on 4/24/2025, at approximately 9:25am, and met with Licensee/Administrator Ami Kumar, and Janine Sorenson, facility Administrator. Facility has an approved dementia plan of operation. There is an approved hospice waiver for three (3) residents. The facility has a required infection control plan. Facility has a required emergency disaster plan. Fire clearance is approved for six (6) non-ambulatory, which includes one(1) bedridden. LPA reviewed six (6) resident files. LPA reviewed six (6) staff files. LPA reviewed staff training. All staff have criminal record clearance as required. All staff have CPR and first aid certification as required. The LPA toured the facility with Administrator Janine Sorenson. Medications were centrally stored, locked and inaccessible to residents in care, and inaccessible to staff not trained to assist residents' with medications. The hot water was checked at 120. degrees Fahrenheit, which is within regulation. Fire extinguisher, 2 of 2, were serviced and tagged as required. All exits were free and clear of obstructions. Facility was found to be clean, orderly, and at a comfortable temperature. Toxins/cleaners are stored in locked cabinets. All exit alarms were on exit doors and working properly during the inspection. All bathrooms had grab bars, and non-slip mats/flooring for bathing as needed. Required postings were up and visible. LPA observed a sufficient supply of perishable and non-perishable food. Continued on LIC809C... Facility had sufficient supply of emergency food & water meeting the "72 hour shelter in place" requirements. Sufficient supply of hygiene items, cleaners, paper products, and personal protective equipment (PPE) for use as needed. Sufficient supply of linens for resident use. LPA observed various activity items, and equipment for residents in care. The facility had sufficient lighting in resident rooms, bathrooms, hallways, and all common areas for resident use as needed. LPA discussed the Licensee/Administrator Ami Kumar PIN24-09 UPDATED DEMENTIA CARE AND MISCELLANEOUS REGULATIONS FOR RESIDENTIAL CARE FACILITIES FOR THE ELDERLY. LPA advised Licensee/Administrator to print and review the PIN to ensure compliance with regulation changes. LPA is requesting the following documents be updated and submitted to CCL by 5/24//2025: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610 - Emergency Disaster Plan- update if needed- submit if changes Copy of Current Liability Insurance Copy of current Administrator Certificate Copy of updated Infection Control Plan- update if needed- submit if changes LIC400-Affidavit of Client Cash Resources There are no deficiencies cited during today's inspection. Exit interview was conducted with Janine Sorenson, Administrator.