Routine inspection·April 29, 2025

Licensing Program Analyst (LPA), Alviso, conducted a Required- 1 Year visit, on 4/29/25 at approximately 10:15am, and met with Administrator John Wotring. Currently there are thirty-nine (39) residents' in care. Facility has a required infection control plan. Facility has a required emergency disaster plan. Facility specializes in dementia care. Hospice care waiver approved for eight (8) residents. Fire clearance approval is for fifty (50) non-ambulatory, which includes approval for twelve(12) bedridden. Per file reviews, emergency disaster drills are being conducted as required. The facility is sprinkled, and has a hard wired smoke alarm system. The facility has four(4) carbon monoxide detectors. Fire extinguishers were serviced and tagged as required. LPA toured the facility with the Administrator. All exits were free and clear of obstruction. All exit doors had working auditory alarms. All toxins were locked up and inaccessible to residents' in care. All medications were observed to be locked up and inaccessible to residents' in care. There is a small refrigerator in the medication room for storing medications that need to refrigerated. The hair salon is kept locked unless the salon staff is working in the salon room; The salon staff comes in twice a week at this time. There was sufficient lighting in hallways, resident rooms, all common areas, and bathrooms. Facility was at a comfortable temperature. Hot water was measured at 113.9 degrees Fahrenheit. Facility kitchen and dining area was observed to clean and orderly during the inspection. Continued on LIC9099C... Facility had a sufficient supply of food. Facility has sufficient emergency supplies, and food supplies to meet the "72 hour shelter in place" requirements. Sufficient supply of linens, paper products, cleaners/disinfectants, hygiene products, and personal protective equipment (PPE) for use as needed. LPA reviewed ten (10) resident files. Resident files were complete. LPA reviewed ten (10) staff files. LPA reviewed staff training. All staff have criminal record clearance as required. Direct care staff have first aid certification as required. Several staff have CPR certification, and on every shift there will be a staff with required CPR certification. LPA is requesting the following documents be updated and submitted by 5/29/25. LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (9-pages, 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 There are no deficiencies cited during today's inspection. Exit interview conducted with Administrator John Wotring.