Facility Evaluation Report

Licensing Program Analyst (LPA) Shannan Hansen arrived unannounced to continue an annual inspection started on 8/13/2024. LPA met with Nancy Steers-Crist, Interim Administrator as Administrator was unavailable.

At approximately 9:00 am LPA conducted file review of 6 staff records, required First aid for staff (S1) was not current, (see LIC9102 TV). Required staff dementia training for S1, S2 & S3 and required Medication training for S2 were not complete (See LI809-D).

LPA reviewed 5 resident records finding all records were current. A review of Centrally stored medications at 1:45pm was conducted to complete this annual inspection.

Administrator certificate for Antonette Edwards #6049701740 expires 9/26/2024.

LPA requesting Licensee to update the following documents by 9/11/2024:

Copy of Certificate of Liability Insurance

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.