Routine inspection·November 2, 2023

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 11/2/23 at approximately 9:50am, and met with Licensee/Administrator Mera Shaughnessey. There are currently six(6) residents in care. Facility has an approved dementia plan of operation. There is an approved hospice waiver for three(3)residents. Facility has an infection control plan as required. Facility has an emergency and disaster plan as required. The facility conducted a fire drill and an earthquake emergency drill on 7/8/23. Facility does have a generator for emergencies if needed. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Facility has a fire clearance approval by the Santa Rosa Fire Department for a total of six non-ambulatory and/or bedridden-effective 12/5/2022. Al exits were free and clear of obstruction. Fire extinguishers, two(2), were serviced and tagged as required-expires 12/5/23. There are nine(9) smoke alarms that are also carbon monoxide detectors. All smoke alarms,, including the hallway fire door worked appropriately during the inspection. All exit doors had auditory alarms and the alarms were working properly during the inspection. The backyard has outside patio furnishings for resident use, including areas providing shade for residents as needed. There was a sufficient supply of hygiene products, cleaning supplies, and paper products for use as needed. All bathrooms had grab bars, and non-slip mat/flooring for bathing/showering as needed; Every resident room has a bathroom that is able to provide showers as needed. There is a large bathroom with a open roll-in shower for resident use as needed. Facility has a sufficient supply of personal protective equipment(PPE).. LPA observed sufficient supply of food, perishable and non-perishable. Facility had sufficient furnishings for residents in care, and the fcility has sufficient lighting in all rooms, bathrooms, and common areas, including night lights. Continued on LIC809C... Medications were centrally stored, and locked up making them inaccessible to residents in care. Toxins/cleaners were locked up making them inaccessible to residents in care. LPA reviewed six (6) resident files; All resident files were found to be complete. LPA reviewed five(5) of five(5) staff files. LPA reviewed staff training. All five(5) staff have criminal record clearance, and are associated as required. All staff had required training. All staff had current First Aid and CPR Certification. LPA is requesting the following documents be updated and submitted by 12/2/23: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to review and update as needed/required) Copy of LIC400 Handling of Client Cash Resources (include copy of surety bond if handling cash) Copy of Current Liability Insurance Resident Roster Copy of current Administrator Certificate During the inspection, the LPA observed several food items that were not covered and stored appropriately to protect the safety and acceptability necessary to prevent contamination, including a package of salami that was covered in mold, soup that was out of date per label and not able to be consumed, and a package of beef meat that was half used and stored inappropriately covered, this deficiency will be cited, 87555(b)(9) Food service requirements shall apply: Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service, see LIC809D. Deficiencies 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. Appeal rights given to the Administrator. Exit interview conducted with Licensee Mera Shaughnessey..