Facility Evaluation Report

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required inspection and met with Licensee Emilce Deller. There are residents with a diagnosis of dementia or hospice.

LPA/Licensee initiated a tour of the facility and made the following observations: facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Extra hygiene products and linens were available. Cleaning supplies are locked in supply closets. Facility has at least two days of perishable and one week of non-perishable foods which appeared to be of quality and stored per regulation. Medications were centrally stored and locked in medication cabinet. Smoke and Carbon Monoxide detectors located throughout the facility that were tested and operational. Exit doors have auditory alert system that were functional at time of visit. Medications and medication records were reviewed. Fire/disaster drill has been conducted in December, 2022. One ouf one fire extinguisher were last inspected May 2023. 4 staff files and 4 resident files were reviewed. Staff does have current required First Aid, CPR certificates and annual required training hours. 4 out of 4 residents does not have their medical assessment and care plans updated within the last 12 months. Licensee/LPA discussed their Emergency Disaster Plan & Infection Control Plan. Administrator Certificate for Administrator, Emilce Deller #6010293740 expires 2/26/2024. Required postings were observed. Water temperature in resident's bathrooms measured 105 and 105.1 degrees F which are within allowable range of 105 to 120 degrees F.

Licensee submitted updates of the following documents: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500) and copy of Liability Insurance.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Licensee and a copy of this report was given.