Routine inspection·March 26, 2024

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by Administrator Mercedes Vegvary. Facility contact information was reviewed. At approximately 9:45am LPA and Admin toured the building and grounds. 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. Food was found to be stored in a safe manner with open items covered. LPA discussed with Admin that all open food items must be covered and labeled with date opened. Kitchen cabinet containing cleaning supplies was locked. All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. 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 106.1 degrees F which is within the allowable range of 105 to 120 degrees F. Facility has 3 fire extinguishers all of which were last inspected during LPA visit today 3/26/2024. Carbon Monoxide detectors were tested and operational as indicated by inspection sticker by fire alarm on March 2023, LPA verified with Santa Rosa Fire Equipment Service Inc technician that facility will have the next service on 3/29/2024, appointment confirmed. Per LPA observation and Admin interview, facility’s quarterly disaster drills are performed with staff individually; however, the facility has not conducted a disaster drill for every employee within the past quarter. Per Health and Safety Code (HSC) 1569.695(c) A facility shall conduct a drill at least quarterly for each shift...documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill (deficiency cited, see 809D). Facility has a backup generator for use during a power outage. Continued on 809C... Continued from 809... At approximately 11:30 am LPA conducted a review of seven [7] resident records. Four [4] out of seven [7] residents (R3, R4, R6, and R7) did not have current Appraisals. Per Title 22 regulation 87463 Reappraisals (c) The licensee shall arrange a meeting with the resident, the resident’s representative, if any, appropriate facility staff, and a representative of the resident’s home health agency, if any, when there is significant change in the resident’s condition, or once every 12 months, whichever occurs first...(deficiency cited, see 809D). At approximately 2:00pm LPA conducted a review of five [5] staff records. Per LPA and Admin review of Guardian roster, staff (S1) does not yet have fingerprint clearance, it is "In Process" per the Guardian roster. S1 has been employed at at facility beginning 8/23/2022. Per Title 22 regulation 87355(d) Criminal Record Clearance (d) All individuals subject to criminal record review shall be fingerprinted (deficiency cited, see 809D. Civil Penalty assessed). LPA advised Admin all employees must have fingerprint clearance in order to work at the facility. Admin agrees to have S1 cease working at the facility until fingerprint clearance is obtained and Guardian roster shows S1 as "Eligible-Clearance." S1 immediately left facility and ceased working. At approximately 12:00pm LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet in the kitchen. LPA and Admin observed pre-poured medications filled in respective residents' pill boxes for the next day and evening. Per Title 22 regulation 87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers (deficiency cited, see 809D). Mercedes Vegvary Administrator certificate 6003396740 expires 6/30/2025. Julius Vegvary Administrator certificate expired 2/18/2023; per LPA review Admin cert for Julius is currently in pending status. All fees are current as of this time. LPA 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 Current lease 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