Routine inspection·September 28, 2023

Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with Executive Director (ED) Diane Pederson, and informed the purpose of visit. LPA also met with Resident Services Director Geraldine Tayo. Facility has an approved LIC808 Mitigation Plan but has not submitted the updated Infection Control Plan. LPA toured the facility inside out with Diane Pederson, Facility is a 3 story building. LPA inspected the common areas, activity room, library, kitchen, dining room and yard. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Freezers and refrigerators temperatures are checked by kitchen staff and recorded daily. Medication room was observed attended by 3 staff. LPA randomly selected 8 residents rooms for inspection - 2 on the first floor, 2 on the second floor and 4 on the third floor. Facility has carbon monoxide and smoke detectors. Hot water temperature in one of the common bathrooms was tested and measured at 113.6 degrees Fahrenheit. Fire extinguisher in the kitchen checked, observed fully charge with tag showed serviced December 28, 2022. Facility has evacuation chairs on stairwells. Facility conducts disaster drills every quarter. LPA reviewed 5 staff and 5 resident's files, and interviewed 2 staff and 2 residents. Medications checked, and compared with records and doctor's orders. Facility does not handle resident's cash resources/P&I. At 12:36 pm, LPA observed chest rub in resident's (R1) room. .....continued on n809C LPA received the following updated/current documents on this same day: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. $3M Liability Insurance certificate 5. Infection Control Plan Deficiency is cited from Title 22 California Code of Regulations, and listed on 809D. F ailure to submit proof of correction by plan of correction due date, and any repeat violation within 12 month period may result in civil penalties. Deficiency and plan and proof of correction were discussed with the ED. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form, and copy of this report provided.