Routine inspection·August 19, 2022

On today’s date, at 10:10 AM, Licensing Program Analysts (LPAs) L. Fici and C. Lin arrived unannounced to conduct an Annual Infection Control Visit. LPAs was greeted by Care staff- Gloria Zulueta outside of the facility. During the inspection, LPAs toured facility with care staff- Magdalena Calubiran, including but not limited to front entrance, kitchen, common areas, hand washing stations, bedrooms, bathrooms, and backyard. LPAs observed COVID-19 signage throughout the facility. Hand washing signs were posted at hand washing stations. LPAs observed paper supplies and PPEs are not sufficient. All sharps and toxins were locked up and inaccessible to residents in care. Common areas are disinfected frequently throughout the day. Water temperature is measured at 109.4. Fire extinguisher was last serviced on 8/4/2021. Facility passages inside and out free of obstruction and does not pose a health and safety risk for persons in care. Continue on Lic809-C Continued on Lic809-C The following deficiencies were observed during inspection: At 10:11AM, LPAs observed fire alarm not functional and beeping. At 11:00 AM, LPAs observed R1 records for care notes not updated and maintained. Care staff stopped recording progress notes on 6/8/2012. At 11:05, Care staff told LPAs that a resident passed away recently, but LPAs observed no resident file that was available. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties . Exit interview conducted with care staff. Appeal right handed along with this report.