Routine inspection·April 3, 2024

Licensing Program Analyst (LPA), Alviso, conducted a Required- 1 Year visit, and met with Administrator John Wotring on 4/3/24 at approximately 9:30am. Facility specializes in dementia care. Hospice care waiver approved for eight (8) residents. Facility has a required infection control plan. Facility has a required emergency disaster plan. Fire clearance approval is for fifty (50) non-ambulatory, which includes approval for twelve(12) bedridden. The LPA toured the facility with Administrator John J. Wotring. All exits were clear and unobstructed. The facility is sprinkled, and has a hard wired smoke alarm system. The facility has four(4) carbon monoxide detectors. All fire extinguishers were serviced and tagged as required, expires 6/1/24. All exits with delayed egress were on and working properly during the inspection. All bathrooms inspected were clean, had grab bars, and non-slip mats/flooring in the showers. LPA observed activities going on with residents in care. Resident rooms inspected were clean and orderly. All resident rooms inspected had sufficient lighting, and all common areas of the facility had sufficient lighting for residents in care. The lights in all hallways are able to be dimmed in the evenings as needed. Food supply was sufficient. LPA observed other staff assisting residents with care services as needed. Facility has a sufficient supply of hygiene products, paper products, cleaners, and a sufficient supply of personal protective equipment (PPE) for use as needed. Facility kitchen, food storage areas, and dining area was observed to be clean and orderly. Medications were observed to be stored appropriately as required, and all medications were inaccessible to residents in care. Cleaners/disinfectants were locked and inaccessible to residents in care. Facility has required 72 hour shelter in place supplies. Continued on LIC809C... LPA reviewed nine (9) staff files. All staff files were complete. All staff had required training. All staff had criminal record clearance. LPA reviewed ten (10) resident files. Deficiency identified from resident file reviews. Five (5) resident files lacked required annual medical assessments. Deficiency will be cited, 87705(c)(5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs, see LIC809D. LPA is requesting the following documents be updated and submitted 5/3/24. 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 when received 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 John J. Wotring. Appeal Rights provided to the Administrator.