Routine inspection·July 5, 2022

On today’s date, Licensing Program Analysts (LPAs) L. Fici and C. Lin arrived unannounced to conduct an annual Infection Control Inspection. LPAs met with care staff Bubby Paclar explained the purpose of visit. Mirriam Paras Administrator (ADM) arrived soon after at 11:30am and greeted by LPAs. LPAs toured facility with ADM including but not limited to front entrance, screening station, hand washing stations, bedrooms, common areas, kitchen, and backyard. Facility has a sufficient 2-day perishable and one-week non-perishable food supply. Visitors policy is posted on the front entrance. There is one central entry point for universal screening for staff, residents, and visitors. A sign-in policy, thermometer and hand sanitizer were observed at screening station. Cough/sneeze etiquette, social distancing and hand washing posters were observed. Common touched surfaces are disinfected at least once daily. Bathrooms are equipped with liquid soap, paper towel and trash bins with touchless lids. Temperature of facility is maintained at 74 degrees F. Facility staff were observed to be wearing proper PPE. Facility has a 30-day supply of PPEs maintained at central location and easily accessible for staff. Facility has a mitigation plan and maintains record of routine screening for residents and staff. Continue on Lic809C Continued on Lic809C The following deficiencies were observed during inspection: 1. 10:40am LPAs observed S1 with no fingerprint clearance working in the kitchen of the facility. Administrator admitted that S1 was volunteer and has not completed criminal background check clearance. S1 was removed from facility during visit. 2. 10:45am LPAs observed a pair of scissors and knife accessible to 2 dementia residents in care. 3. 10:45am LPAs observed a greasy broken cabinet with no hinges above the stove. 4. 10:48am LPAs observed Lactulose Solution and various medications belonging to residents on the kitchen counter that were accessible. 5. 11:00am LPAs observed cleaning supplies accessible to persons in care. The above 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. A civil penalty was assessed for the amount of $500 The following forms are to be updated and submitted to CCLD By 7/12/2022. - LIC500- Personnel Report - LIC308- Designation of Administrative Responsibility - LIC610E- Emergency Disaster Plan Exit interview conducted with Administrator and a copy of this report provided along with Appeal rights.