Routine inspection·April 28, 2022

On 4/28/2022 at 1:05PM, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct an Infection Control Inspection. LPA met with Gertrudes Sabadera, Caregiver and explained the purpose of the visit. Restituto Sabadera arrived at 1:30PM. Upon entry, LPA's temperature was not checked. LPA observed screening station that contained hand sanitizer, masks and COVID signage. LPA toured facility including but not limited to common areas, bathrooms, bedrooms, kitchen, garage and backyard. LPA observed cough etiquette and physical distancing posted in the common areas. All hand washing stations were equipped with soap and paper towel. Hot water temperature in the shared residents' bathroom was measured at 115.2 degrees Fahrenheit. Fire extinguisher was last serviced on 11/22/2021. During record review, LPA observed facility has a copy of Mitigation Plan on file. LPA observed PPE, food, and paper supplies are sufficient. The following forms are to be updated and submitted to CCLD by 5/5/2022 : -LIC500 Personnel Report -LIC308 Designation of Administrative Responsibility Continued on LIC9099C Continued from LIC9099. -LIC610E Emergency Disaster Plan -An updated copy of Administrator certificate The following deficiencies were observed: -At 1:10PM, LPA observed two (2) bottles of medicine for Staff 2 (S2) and medication for Resident 4 (R4). -At 1:15PM, LPA observed spider webs on light fixture in kitchen, crumbs and deceased insects on kitchen floor near patio door, unsanitary kitchen floor. -At 1:20PM, LPA observed a can of raid, two (2) knives, and calcium pills sitting on kitchen counter. Kitchen drawer near sink containing knives was unlocked. Roach crawling on kitchen counter and kitchen floor. Gnats flying around kitchen area. -At 1:25PM, LPA observed cabinet above counter unlocked containing medication. -At 1:32PM, LPA observed refrigerator unsanitary. Medications in refrigerator accessible. -At 1:37PM, LPA observed a gallon of Clorox and a gallon of disinfectant sitting near office. Office is located near front door. -At 1:45PM, LPA observed Resident 1 (R1) and Resident 4 (R4) sharing bedroom #1. In the closet was R4's clothing. -At 1:47PM, LPA observed women clothing hanging in bathroom that is located in bedroom #1. Uncleaned underwear in a plastic bowl sitting in sink. Administrator stated for owners only. A bedroom cannot be used as a passageway. -At 1:57PM, LPA observed garbage cans with trash located on ramp leading into backyard from kitchen patio door. Three (3) shower chairs sitting, trash bags containing recyclables, and two (2) commodes sitting on left-hand side of house. -At 2:25PM, LPA observed four (4) cans of expired can goods. Continued on LIC9099C. Continued from LIC9099C. -At 2:50, LPA reviewed residents file and observed R1 and R2's file has not been completed. Both files are missing Admission agreement, appraisal needs and services plan, personal rights, identification and emergency contact, preplacement appraisal, physician's report and consent form for R1. -At 3:45PM, LPA observed R1 in wheelchair with a Velcro restraint closed in back of wheelchair. The following deficiencies were observed (see LIC809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.