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25 | Licensing Program Analyst (LPA) Raygoza conducted an unannounced Annual Random inspection and met with Assistant Administrator, Nekdiljka Buljan. LPA toured the facility inside and outside the facility premises. Tour began in the kitchen and LPA observed sufficient two day and seven day nonperishable food supply. Medication was observed to be in a locked cabinet. Kitchen tools and knives were in a locked drawer. Chemicals and cleaning solutions were observed to be in a locked storage closet area. Facility appears to be clean and odor free. Comfortable temperature throughout facility.
LPA observed all resident bedrooms to have adequate lighting and furniture. There were seven residents present at the time of the visit. There are ample clean linen and bedspreads in closet area. There are seven private rooms for residents and all rooms have private bathrooms. Resident bathroom's have showers with grab bars, non-slip mats and nonskid floors. Hot water was tested and measured 105 degrees F. Working phone on premises is (650) 358-8718. First Aid kit is available. Facility is equipped with fire alarm, smoke detectors and carbon monoxide detector on premises. Disaster/Fire drills are conducted every six months. The Emergency Disaster Plan and CCL forms are visibly posted in kitchen. Staff and resident files were randomly reviewed. Medications and medication logs randomly reviewed. Exterior grounds of the facility have clear passageways and free of obstruction. There are no accessible bodies of water. Alarms are installed and operable on all exit doors. Administrator's Certificate, Ante Buljan expires on 1/10/2021.
The following forms to be submitted to CCL Office by 9/23/19:
LIC 308 Administrative Responsibility Designation
LIC 500 Personnel Report
No Deficiency cited.
This report was reviewed, discussed and a copy given to Assistant Administrator, Ante Buljan |