Providence Place.

On 8/8/2024, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by Caregiver Staff, Joy Bautista. Wellness Director, Catherine Villegas was contacted and arrived later in the visit. The facility currently provides care for 34 residents, 2 of which are receiving hospice services and some of which with a diagnosis of dementia. LPA continued with a tour of the facility with staff, facility found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers located on each floor were found to be last charged on 6/6/2024. Smoke and carbon monoxide detectors are interconnected. Fire Safety Inspection was completed on 7/23/2024 indicating all fire safety devices and systems to be in order. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations, with food stored in the kitchen refrigerator found to have appropriate coverings, sufficient for residents in care. Facility allows residents to choose meals on various preferences while also ensuring proper dietary restrictions are followed. Cleaning supplies and other toxins are safely stored in locked closets throughout each floor, all of which were secured upon inspection. There was a supply of hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings and bedding items. Residents that were awake during the inspection were observed interacting with staff in the common areas, or in their bedroom resting. In addition, there is large outdoor backyard space for resident use. The facility encourages regular family visits and utilizes a wide variety of activities. The Activities Director and caregiver staff were observed engaging continuously with residents, offering activities based on individualized preferences and abilities. LPA found that the engagement is very well practiced with activity calendars developed on a monthly. Residents were observed to have a positive relationship with staff. Continued onto LIC809-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA conducted a sample file review for 10 residents and found three (3) residents requiring Needs & Service Plans updated. Upon a check of spot check of seven (7) staff files, LPA found that caregiving staff have current 1st aid and CPR and annual training on schedule for completion. LPA found that the staff require additional training on dementia care. LPA was informed that the training has been scheduled for this month. Licensee to ensure training for staff is completed by 9/8/2024. Technical Assistance. Lastly, A spot check of medications was conducted and found that all medication counts and records are in order. Galina Knop's Administrator Certific ate 7034765740 is c urrently active through 2/21/2025. Roman Knop's Administrator Certificate 7034766740 is currently active through 12/1/2025. LPA requested the following documents be sent to CCL by COB 8/22/2024: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Liability Insurance Deficiency 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.