Routine inspection·May 13, 2025

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. Facility mailing address needs to be updated. LPA will update once back in office. Martha Marimbi Administrator Certificate 7018478740 expires 3/21/27. At approximately 9:30am LPA and Admin toured the building and grounds. The facility was found to be at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Bag of sugar in pantry had ants crawling both inside and outside of the bag, strawberries in jar had brown fuzzy substance, and bag of Honey Nut Cheerios was open but not sealed or clipped shut ( deficiency cited, see 809D ). Kitchen drawer with sharp knives locked. Cabinets to the right hand side of kitchen sink both broken, and ceiling vent on hallway heavily covered in dust and debris ( deficiency cited, see 809D ). 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 bathroom had required bath mat and grab bar. Prescription Calmoseptime for R2 in unlocked drawer in bathroom used by most residents ( deficiency cited, see 809D ). Scissors in unlocked drawer in bathroom used by most residents ( deficiency cited, see 809D ). LPA observed common towel in resident bathroom. Admin immediately removed and replaced with paper towels. Water temperature in sink accessible to residents in care measured at 118.7 degrees F in the bathroom by the laundry room which is within the allowable range of 105 to 120 degrees F, but measured at 100.5 degrees F in the kitchen and in the hallway bathroom. Admin will contact landlord to get temperature within regulation in all bathrooms and kitchen. Continued on 809C... Continued from 809... Fire extinguishers were last inspected 2/27/25. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drills were conducted February 2025. Facility has a backup generator for use during a power outage. At approximately 11:30am LPA conducted review of 5 staff records. LPA went over staffing roster with Admin and staffing schedule. S1 has been working since 9/24/24 however, S1 does not have fingerprint clearance. Per Guardian, S1 was determined "not eligible - determination closed.". LPA advised Admin that S1 cannot be present at or working in any capacity at the facility until such time that fingerprint clearance is obtained. S2 has been working since 3/1/22 but as of 1/14/25 they had a rap back and as of 4/8/25 was denied an exemption. LPA advised Admin that S2 cannot be present at or working in any capacity at the facility ( deficiency cited, see 809D - civil penalties assesse d , see LIC421BG ). S3 had one hour of training on file and S4 had 16 hours of training on file ( deficiency cited, see 809D ). At approximately 1:30pm LPA conducted a review of 6 resident records. All required documentation present. R1 is not on hospice but has unstageable pressure ulcer on left big toe ( deficiency cited, see 809D ). Admin to submit paperwork to CCL for exception request. Admin to submit care plan and wound care plan as part of paperwork submitted. All documents for pressure ulcer exception to be submitted to CCL no later than 5/22/25. At approximately 2:30pm LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. No deficiencies. 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, Current Lease 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 .