Routine inspection·August 6, 2024

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by caregiver. Administrator Jessica Robles arrived later. Facility contact information was reviewed. At approximately 10:30am 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. Food items were found to be uncovered in the refrigerator such as watermelon, grains and cereals in canisters without dates of filling/opening, and canned and boxed goods found with expired best if used by dates: various brands of peanut butter with best if used by dates of 8/28/2023,12/7/2023, 5/15/2024, and 1/16/2024; canned mini raviolis with best if used by date of 6/5/2023; box of Rice a Roni with best is used by date of 2/14/2024; can of Manwich with best if used by date of 11/22/2023 ( deficiency cited, see 809D ). Kitchen cabinet containing cleaning supplies was not locked, however cabinet is located behind baby gates. Kitchen drawer with sharp knives locked. All bedrooms were equipped with lighting, night stand, and chest of drawers. LPA and Admin observed bedroom #1 in Memory Care main house found to have strong urine smell, per Admin the urine smell is from the mattress. Shared room in cottage #2 had a bed that smelled strongly of urine ( deficiency cited, see 809D ). Bedroom #4 had broken wall outlet cracked and missing the right side portion of face plate and internal box visible. Extra hygiene products and linens were available. Half bath in Memory Care main house did not have working fan or lights, switches did not work ( deficency cited, see 809D ). All other resident bathrooms had required bath mat and grab bar. Water temperature in sink accessible to residents in care measured at 117.3 and 111 degrees F which is within the allowable range of 105 to 120 degrees F. Continued on 809C... Continued from 809... One [1] out of five [5] fire extinguishers were last inspected 3/5/2024 and four [4] out of five [5] fire extinguishers were last inspected 8/5/2024. Carbon Monoxide detectors were tested and operational as indicated by Fire Marshall sticker by fire alarm in March of 2024. Facility has a backup generator for use during a power outage LPA conducted a review of 5 resident records. Three [3] out five [5] residents R1, R2, and R3 did not have a current appraisal and R1 has a diagnosis of dementia but their most recent physician's report is dated 5/10/2023 (deficiencies cited, see 809 D ) . LPA conducted review of 6 staff records. Five [5] out of [6] staff, S1, S2, S3, S5, and S6 did not have current annual training completed (deficiency cited, see 809D ) . S6 did not have fingerprint clearance and was not associated to the facility. Per Guardian, S6 fingerprint application was received 3/29/2023 and closed for incomplete application on 6/27/2023. Reasons listed were #8, #9, and #20 ( deficiency cited, see 809D and *civil penalty assessed *). LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked room. No deficiencies Jessica Robles Administrator Certificate 7028206740 expires 5/16/2026. All fees are current as of this time.. 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, and 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 Licensee. 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 .