Facility Evaluation Report, 12/01/2023 — Haave House, Oak View CA

At 09:05 a.m. Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit. The LPA was greeted by Licensee Bonnie Haave and informed them of the reason for the visit.

Record Review: At 09:15 a.m. a review of facility files was initiated. The LPA reviewed five (5) out of six (6) resident files. The LPA reviewed five (5) out of five (5) staff files. The LPA observed documentation of Infection Control, Disaster prevention and last fire drill (conducted on 10/10/2023). The LPA obtained a Client Roster and Staff Roster. All documents reviewed appeared complete and current.

I nterviews: At 12:30 p.m. the LPA conducted two (2) staff and two (2) resident Interviews. No immediate concerns were voiced.

Medications: At 1:00 p.m. a medications review was initiated. Medications are centrally stored and locked in a hallway closet; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record, however, start dates for several medications of all residents were not documented. A conversation was held between the LPA and Licensee Bonnie of the importance of best practice in writing a start date for all medications. Licensee Bonnie stated that moving forward, the start date for all medications will be documented.

At 02:40 p.m. the LPA conducted a tour of the physical plant with Licensee Bonnie Haave to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: Facility is a single-story residence that consists of six (6) resident bedrooms, one (1) staff room, and two (2) restrooms. The LPA observed one (1) fire extinguishers which was fully charged and last serviced 01/02/2023. All smoke alarms and carbon monoxide detectors were tested and functioned properly. The LPA observed all required postings in the hallway near the kitchen. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. Report will continue on LIC809-C.