Routine inspection·April 29, 2022

On 4/29/22 at 3;15pm, Licensing Program Analysts (LPAs) K.Nguyen, and L. Francisco arrived unannounced to conduct Infection Control Inspection. LPAs met with Administrator, Samuel Tet and explained the purpose of the visit. During the Infection Control Inspection, LPAs toured facility including but not limited to front entrance, hand washing stations, bedrooms, common areas, and kitchen. 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, and hand sanitizer were observed. Cough/sneeze etiquette, social distancing and hand washing posters were observed. 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. THE FOLLOWING DEFICIENCY WAS OBSERVED DURING VISIT -At 3:30 PM, LPAs observed fruit being stored on the same shelf as cleaning supplies. LPAs observed Administrator remove fruit from shelf. Deficiency cleared during visit. REPORT CONTINUES ON 809C Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 5/13/2022: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency by POC date may result in additional Civil Penalty Exit interview conducted. Appeal rights and a copy of this report provided.