Routine inspection·April 28, 2023

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required inspection and met with Licensee Josephine Blancaflor. There are residents with a diagnosis of dementia or hospice. LPA/Licensee initiated a tour of the facility and made the following observations: facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Extra hygiene products and linens were available. Cleaning supplies are locked in supply closets. Facility has at least two days of perishable and one week of non-perishable foods which appeared to be of quality and stored per regulation. Medications were centrally stored and locked in medication cabinet. Smoke/Carbon Monoxide detectors located throughout the facility that were tested and operational. Exit doors have auditory alert system that were functional at time of visit. Medications and medication records were reviewed. Fire/disaster drill has been conducted in January 2023. Three staff files and five resident files were reviewed. Staff does have current required First Aid, CPR certificates and annual required training hours. All residents have their medical assessment and care plans updated within the last 12 months. Administrator and LPA discussed their Emergency Disaster Plan and Infection Control Plan. Administrator Certificate for Administrator, Josephine Blancaflor #6015304740 expires 7/14/2024. Required postings were observed. Water temperature in resident bathroom measured 110.8 degrees F which are within allowable range of 105 to 120 degrees F. At approximate 1:00pm LPA/Licensee observed two out of two fire extinguisher were last inspected August, 2021. Licensee called immediately Sebastopol Fire Department to have them come and service them. Licensee submitted updates of the following documents: Designation of Administrative Responsibility (LIC308) and Personnel Report (LIC500) and a copy of Liability Insurance. 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. Appeal rights given. Exit interview conducted with Licensee.