Routine inspection·December 20, 2024

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by Administrator Melissa Genet: Administrator Certificate 7021074740 expires 12/1/25. Facility contact information was reviewed. At approximately 11:00am 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. Hall closet containing cleaning supplies was locked. Kitchen drawer with sharp knives locked. LPA observed prescription milk of magnesia on an open shelf in the kitchen along with thickener. LPA discussed with Admin keeping all medication, including over the counter items and nutritional supplements in the medication closet as it must remain inaccessible to residents. Admin immediately removed items from shelf and secured them in the medication cabinet. The main bathroom across from the living room has a little closet that houses the sprinkler equipment. The door to the closet is splintering and cracking at the bottom posing a safety hazard to residents. The main bath next room #9 had a leak under the sink. The leak has been fixed but the wood/plywood/sheathing on the bottom/base of the vanity cabinet has a black substance present with spots and dots of a white fuzzy substance ( deficiencies cited, see 809D ) All bedrooms were equipped with lighting, night stand, and chest of drawers, except for resident (R2) . R2 did not have a lamp. Admin says they broke it and family doesn't want another one in there. LPA advised get a note from the family and put it in the resident's file. 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 108.6 degrees F which is within the allowable range of 105 to 120 degrees F. Continued on 809C... Continued from 809... Fire extinguishers were last inspected 3/29/24. Smoke/Carbon Monoxide detectors and sprinklers located throughout the facility are hardwired and serviced by a vendor. Most recent date of service was March 2023 and service sticker indicates that it is a 5 year inspection. Facility’s last quarterly disaster drills were conducted 10/15/24. Facility is part of a community that share a water source. Community currently has extremely high levels of arsenic in the water. Previous to this annual inspection, facility Admin reported water issue to CCL and CCL has been in communication with the Dept of Health and the Water Board. A solution to this water issue is currently being developed between all involved parties. However, the facility water is dangerous for human consumption and cannot be ingested, although it can be sued for bathing. The facility is using paper dishes and utensils and/or washing all cooking pots, cups, and utensils in boiled water, ensuring the temperature is maintained within regulation of at least 170 degrees F. LPA observed notice posted disclosing water warning above the guest book sign in. LPA and Admin discussed adding a notice above facility sinks in residents rooms, and in the kitchen. Admin will provide pictures of added notices to CCL no later than 12/23/24. At approximately 12:15pm LPA conducted a review of 5 resident records. Residents R1, R2, and R4 did not have current physician's reports on file or a current appraisal. R3 did not have a current appraisal on file ( deficiencies cited, see 809D ). LPA observed full bed rails being used on R1’s bed. Based on LPA interview with Administrator, the facility has not requested an exception for the full bed rails from the CCL as required. Administrator agreed to submit pertinent documents to CCL for review by no later than 12/30/24. At approximately 1:00pm LPA conducted review of 5 staff records. All continuing staff have not completed the required 20 hours of annual training, and staff (S3) is a new hire as of 2024 and has not completed the required 40 hours of training ( deficiency cited, see 809D ). S1 did not have a Health Screen on file ( deficiency cited, see 809D ) At approximately 2:00pm LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. Continued form 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 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 Admin. 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 .