Routine inspection·May 9, 2024

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual Inspection and was greeted by Administrator Martha Marimbi. Facility contact information was reviewed. At approximately 9:30am 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. Kitchen drawer with sharp knives locked. Food in kitchen refrigerator was found to be stored in a safe manner with open items covered. Food in storage refrigerator had bag of lettuce filled with brown liquid and browning lettuce heads. LPA and Admin observed all non-perishable goods that were checked in storage area to be years beyond the best if used by date (BIYB). Items include: cans of canned fruit with BIYB date of 2021, 2022, and 2023, cake mixes with BIYB of 2020 and 2022, box of quick oats with BIYB of 2023, can of whole tomatoes with BIYB of 2022, several boxes of macaroni and cheese with BIYB of 2022 ( deficiency cited, see 809D). LPA and Admin observed laundry room soaps and toxins inside locked laundry room. Laundry room has three doors: one for entry, one leading to a bathroom that resident in room #1 utilizes and the other door leads to the hallway. LPA observed the entry door to be locked, LPA observed the two doors leading out to be locked from the inside; however, laundry room could become accessible to residents, if door accidentally left unlocked. Admin to lock up laundry soaps and toxins in standing cabinet present in laundry room as a precaution. 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 bathrooms had required bath mats and grab bars. Water temperature in sink accessible to residents in care measured at 105.6, 105.5 and 105.4 degrees F which is within the allowable range of 105 to 120 degrees F. Continued on 809C... Continued from 809C... Fire extinguishers were last inspected 4/2/2024. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational as indicated per Santa Rosa Fire Equipment service sticker dated Jan/2024. Facility’s last quarterly disaster drill conducted 2/5/2024. At approximately 10:15am LPA and Admin observed the following items in need of repair: wooden fence surrounding facility backyard perimeter in disrepair in several different places. LPA and Admin observed vanity in main bathroom to have eroded paint at bottom and exposed particle board with dark brown/black film around the base and in the corner. LPA and Admin observed bathroom in room #3 to has bubbling and lifting linoleum in the left corner by the toilet ( deficiency cited, see 809D ). At approximately 12:00pm LPA conducted a review of 6 resident records. Appraisal Needs and Services Plan (ANS) for two [2] out of six [6] residents were over one year old; ANS for R1 was dated 1/30/23 and ANS for R2 was 2/6/2023 ( deficiency cited, see 809D ). At approximately 12:30pm LPA conducted review of 5 staff records. Five [5] out of five [5] staff did not have current 1st Aid/CPR certification ( deficiency cited, see 809D ) . Three [3] out of five [5] staff did not have Health Screens ( deficiency cited, see 809D ). At approximately 1:00pm LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. No deficiencies. Martha Marimbi Administrator Certificate 6051254740 expires 3/21/2025. Fees are due. LPA gave Admin LIS printout with PIN to make payment online. 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 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 Administrator. 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