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Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Kesha Lewis arrived at this facility unannounced to conduct a Required 1 Year Annual Inspection Visit. LPA were met by Staff member and Administrator joined 5 minutes later. LPA were screened upon entry for COVID precautions. LPA explained the purpose of the visit to Administrator. LPA and Administrator inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry area, living area and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations. Facility is a 6 bed facility with a current census of 6. There is entry door is leading to the living room, kitchen with a hallway to the bedrooms and bathrooms. The hallway has COVID precautions in place including social distancing noted. Chemicals and medications noted to be locked to residents in care. LPA also conducted the care tool. Hot water temperature was measured at 107 F degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees Fahrenheit. All necessary documents were in place. LPA observed the following posted on the facility wall: Facility license, sketch, See Something Say Something poster, Ombudsman poster, Theft and Loss Policy, Resident Bill of Rights, Rights of Resident/Family Councils. The facility submitted a LIC 808 mitigation plan, which was approved. The facility has central entry point and has implemented screening and sign in procedures at the front door area. The facility conducts routine symptom screening for employees, residents, and visitors LPA observed the facility to have hand washing stations, COVID - 19 informational signage, and social distancing signs posted throughout the facility, on the front door, and outside. The facility has a designated infection control lead individual. The facility is able to designate and dedicated a COVID -19 room/bathroom if needed. Common touch surfaces are cleaned after each use. LPA observed the facility to have adequate food supply of 7 days non-perishables and 2 days perishables in place. Resident rooms were sanitary and had the required furniture and furnishings. LPA observed, fire extinguishers inspected on 05/01/2023 and current, smoke and carbon monoxide detectors, central heating and air in the facility. The first aid kit was found in compliance containing at least the following: a current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency, sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, and Antiseptic solution. LPA reviewed two (2) staff files. All staff is fingerprint cleared and associated to the facility and staff have current First Aid or CPR certifications on file. Facility is conducting initial and continuing training as required. LPA reviewed three (3) resident facility files, COVID-19 Plan, and survey binder. All necessary documents were in place. Exit interview held with staff and copies of reports left at conclusion of visit.the state’s words, verbatim · CDSS document, Oct 17, 2023

Allegation investigated: Staff do not properly store food at facility

Licensing Program Analyst (LPA) Kesha Lewis conducted an unannounced complaint visit to inform the licensee of complaint findings mentioned above. LPA met with Staff and explained the purpose of the visit. Based on LPA'S interview of Staff 1 (S1) the above allegation of -Staff do not properly store food at facility is SUBSTANTIATED. CCLD finds the allegation of Staff do not properly store food at facility to be SUBSTANTIATED. A finding that the complaint allegation is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.the state’s words, verbatim · CDSS document, Jan 26, 2023 · control 27-AS-20221222164154

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(8) · Plan of correction due date: Feb 6, 2023

General Food Service Requirements (b) The following food service requirements shall apply:... (8) All food shall be of good quality. ... This requirement was not met as evidenced by: Based on LPA'S interview with S. S1 stated the food order was delivered the day before the VMRC visit and it was by accident that the food was left out. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 26, 2023

Plan of correction: The Licensee threw away the yogurt, juice, and cottage cheese in addition, an in service training will conducted and proof of training will be sent to LPA Lewis by POC due Date. Kesha.Lewis@dss.ca.gov

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA's) Kesha Lewis and Albert Johnson arrived at this facility unannounced to conduct a Required 1 Year Annual Inspection Visit. LPA's were met by caregiver and screened upon entry for COVID precautions. LPA's explained the purpose of the visit to caregiver. Administrator's Certificate # 6001906740 Expires 7/06/2023. LPA's and Staff inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry area, living area and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations. Facility is a 6 bed facility with a current census of 6. There is entry door is leading to the living room, kitchen with a hallway to the bedrooms and bathrooms. The hallway has COVID precautions in place including social distancing noted. Chemicals and medications noted to be locked to residents in care. LPA's also conducted the infection control domain tool. Hot water temperature was measured at 108 F degrees Fahrenheit in resident Kitchen sink, which is within the required range of 105 to 120 degrees Fahrenheit. All necessary documents were in place. Smoke and carbon detectors were in good repair. Fire extinguishers are current and inspected on 04/22/2022. LPA's observed the following posted on the facility wall: Facility license, sketch, See Something Say Something poster, Ombudsman poster, Theft and Loss Policy, Resident Bill of Rights, Rights of Resident/Family Councils. The facility submitted a LIC 808 mitigation plan, which was approved. The facility has central entry point and has implemented screening and sign in procedures at the front door area. The facility conducts routine symptom screening for employees, residents, and visitors. LPA's observed the facility to have hand washing stations , COVID - 19 informational signage, and social distancing signs posted throughout the facility. LPA's observed the facility to have hand washing stations, COVID - 19 informational signage, and social distancing signs posted throughout the facility. The facility has a designated infection control lead individual. The facility is able to designate and dedicated a COVID -19 room/bathroom if needed. Common touch surfaces are cleaned after each use. LPA's observed the facility to have adequate food supply of 7 days non-perishables and 2 days perishables in place. Resident rooms were sanitary and had the required furniture and furnishings. LPA reviewed four (2) staff files. All staff is fingerprint cleared and associated to the facility and staff have current First Aid or CPR certifications on file. Facility is conducting initial and continuing training as required. LPA reviewed two (2) resident facility files, COVID-19 Plan, and survey binder. All necessary documents were in place. LPA requested updated copies via email to LPA by August 29th , An Infection Control plan for Monkey pox's Per California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed during this visit. An exit interview was held, and a copy of the report was left at the facility.the state’s words, verbatim · CDSS document, Aug 22, 2022

Type of visit: Required - 1 Year

On 09/3/21 at 12:45 PM LPA Bruce Jacobs arrived at this facility unannounced to conduct an annual inspection visit. LPA was met by care staff who informed Administrator Lynn Caoli of the LPA's visit and Ms. Caoli arrived during the visit. LPA explained the purpose of the visit and staff accompanied LPA on the facility inspection. LPA Jacobs inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry area, living area and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations. Facility is a 6 bed facility with a current census of 6. There are 3 client bedrooms and 2 client bathrooms. There is entry door is leading to the living room, kitchen with a hallway to the bedrooms and bathrooms. The hallway has COVID precautions in place including social distancing and other signage noted. Medications noted to be locked to residents in care. LPA also conducted the infection control domain tool. The facility submitted a LIC 808 mitigation plan, which was approved. The facility has central entry point and has implemented screening and sign in procedures at the front door area. The facility conducts routine symptom screening for employees, residents, and visitors. LPA observed the facility to have hand washing stations, COVID - 19 informational signage, and social distancing signs posted throughout the facility, on the front door, and outside. The facility has a designated infection control lead individual. The facility is able to designate and dedicated a Covid-19 room/bathroom if needed. Common touch surfaces are cleaned after each use. LPA observed the facility to have adequate food supply of 7 days non-perishables and 2-days perishables in place. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguishers were checked April 2021 and are in compliance. Facility has an emergency food and water supply in a separate storage area in kitchen. LPA requested the following documents to be updated: LIC 500 and LIC 309 as needed. Per California Code of Regulations, Title 22 no deficiencies were observed during this visit. Exit interview was held and a report was given to Lynn Caoli..the state’s words, verbatim · CDSS document, Sep 3, 2021

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.