Routine inspection·April 18, 2025

License Program Analyst (LPA) Hansen arrived unannounced to conduct an Annual Required - 1 Year inspection of the facility. LPA met with Administrator Karina Medina. This single story senior living community is a full memory care facility with 40 apartments. Facility has a fire clearance by Petaluma Fire Department for 80 non-Ambulatory residents and has a Hospice Waiver approved for 20. There is a total of 48 residents with 13 residents currently receiving Hospice services. LPA toured the facility on 04/18/2025 at 9:45 AM with Administrator and Director of Health Services (DHS) Lupe Villa-Guerrero; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. The tour of the facility included nine resident apartments, activity rooms, Library, music room, dining rooms, kitchen and outdoor patios & courtyard. Facility serves residents with dementia and has special care plan of operation and programming. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations at the time of the visit. Food was found to be handled and stored in a safe manner. Facility kitchen has a binder with all resident’s names and their needs. Menu is posted. Food is available for residents any time of the day. Fire Extinguisher was found to be last charged on 12/6/2024 at the time of the visit. Facility smoke detectors are hard wired and sound directly to the fire station. Smoke detectors and fire sprinklers are inspected by a vender with the last inspection being conducted on 11/15/2024. LPA observed Carbon monoxide detectors that were found to be operational during the visit. There are emergency lights in many of the fixtures in the common areas of the facility that come on should a power outage occur. Continue on LIC 809-C Continue from LIC 809- Hot water temperature measured between 108.6 degrees F and 115 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 9 of 9 resident’s bathrooms while touring facility. Resident bathrooms had required slip resistant mats and grab bars. Toxins are stored in a locked housekeeping room; although at 10:05am LPA & Administrator observed Janitorial Closet on Side 1 left ajar/open with toxic cleaning chemicals accessible to residents in care (see LIC809-D). During inspection LPA & Administrator observed 26 missing window screens on the inside courtyard & exterior of facility, along with additional damaged screens (see LIC809-D) Regional Director of Health & Wellness informed, there is a screen project with repair service to come out and repair & replace window screens. There was a supply of cleaners, hygiene products and paper products available for residents. A sample tour of resident’s bedrooms was conducted, and bedrooms inspected have lighting & appropriate furnishing. Beds were outfitted with mattress pads as required by Title 22 Regulations on 4/18/2025 at 10:30 AM. A sample review of six resident & six staff records as well as two resident’s medications was conducted. LPA reviewed resident’s files at 12:15 PM on 4/18/2025 and learned that 6 out of 6 residents have an updated reappraisal/needs & care plan on file as well as medical assessments at this time as required by Title 22 Regulation. Medications were centrally stored in two locked medication carts in the facility medication room. The Medications of 2 out of 2 residents were found to be given according to physicians’ directions on 4/18/2025 at 2:30 PM. Centrally Stored Medication Record (CSMR) of 2 out of 2 residents were found to be complete and accurate. LPA conducted a sample reviewed of staff records at 1:30 PM on 4/18/2025 and learned that all facility staff and other individuals who require caregiver background checks have received criminal record clearances or exemptions. In addition, Direct care staff have received the additional training requirements as per Title 22 Regulations and H&S Code. LPA was presented with proof of CPR & 1 st Aid certification for required staff. Disaster Drills have been conducted quarterly in different shifts with the last one being conducted on 3/20/2025. In case of disaster and power goes out, facility has a permanent generator that self tests once a week. Karina Medina Administrator Certificate # 6076069740 expires on 3/11/2027. Continue on LIC809-C Continued from LIC809-C Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided. LPA Hansen is requesting Licensee to update the following documents by 5/7/2025: LIC 308 Designated -if changes LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan – if changes LIC 9020 Register of Facility Client’s/Resident’s Copy of Administrator Certificate Copy of Certificate of Liability Insurance