Routine inspection·January 31, 2024

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by Caregiver. Administrator Kelly Eriksen arrived later. Facility currently has two [2] residents on hospice which is allowable per the facility's Hospice Waiver for two [2]. One resident is bedridden and resides in bedroom with bedridden fire clearance per STD850. 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. Food was found to be stored in a safe manner with open items covered and labeled. Kitchen cabinet containing cleaning supplies and sharp knives was locked. All bedrooms were equipped with lighting/lamp, 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(s) accessible to residents in care measured at 112 and 110.5 degrees F, respectively which is within the allowable range of 105 to 120 degrees F. Fire extinguishers were last inspected 1/29/2024. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Exit doors have an auditory alert system that was functional at time of inspection. Facility’s last quarterly disaster drill was conducted on 1/12/2024. Facility has a backup generator for use during a power outage. At approximately 11:35am LPA conducted a review of six [6] out of six [6] resident files. All required documents present. Continued on 809C... Continued from 809... At approximately 1:15pm LPA conducted a review of five [5] out of five [5] staff files. Two [2] out of five [5] staff members did not have the required number of hours completed. Staff (S1) and (S2) are in their first year of employment and have completed 16 hours of training. Per Health and Safety Code 1569.625 - Staff training; legislative findings; contents (b) (1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required... ( deficiency cited, see 809 ). At approximately 2:30pm LPA and Admin conducted a spot check of medication and medication records. No discrepancies observed. Medication is centrally stored in a locked closet in the hallway. Kelly Eriksen Administrator Certificate 6027539740 expired 11/4/2023; however, Admin provided proof of Admin cert renewal docs submitted 1/19/2024. All fees are current as of this time. LPA and Admin discussed facility's Infection Control Plan and Emergency Disaster plan. Licensee will send copy of updated Emergency Disaster plan to CCL within 30 days. No updates made to Infection Control Plan. 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 Emergency Disaster Plan Evidence of 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.