Routine inspection·October 20, 2021

Licensing Prog ram Analyst (LPA) Delmund conducted an unannounced infection control annual inspection. LPA met with Associate Executive Director (AED) Rosana Frias and informed the purpose of visit. Facility is a seven story building, 2nd and 3rd floors of which house assisted living residents. Facility has a completed COVID-19 mitigation plan that was approved on April 12, 2021. LPA inspected the facility inside and out with Rosana Frias. LPA observed screening station located near the front entrance with visitor's log, hand sanitizer and no touch temperature probe; surgical masks and disposable gloves are readily available at the front desk. . Routine symptom screening (+/-) temperature and symptom checks are done at entry for all staff and visitors. Residents are screened for COVID-19 symptoms and temperature checked daily. LPA observed COVID-19 physical distancing signages posted in common areas. Infection control designated leader is the wellness coordinator. Medications are centrally stored in the medication room attended by med-techs, wellness coordinator and wellness director. Adequate supply of centrally stored PPEs was observed. There were at least 7 days of nonperishable and 2 days of perishable foods. Facility maintains daily log of freezer temperature. Fire extinguisher in the kitchen was observed fully charged and tag showed serviced March 29, 2021. Smoke and carbon monoxide detectors were operational. Facility room temperature was tested and measured at 69 degrees Fahrenheit. LPA randomly selected 5 resident rooms on the second floor and 5 resident rooms on the third floor for inspection. ......continued on LIC809C LPA observed the following: 1. Three cans of gallon size expired prunes (expiration date: June 2020) and 1 of the cans was rusted. 2. No handwashing signage in the bathrooms and trash cans with no lids in resident's rooms including the shared room. 3. No updated visitor's poster on the entrance door. 4. No cough and sneeze etiquette posters. LPA requested for copies of the following updated documents to be submitted to Community Care Licensing (CCL) by November 3, 2021: 1. LIC500 Personnel Report 2. LIC308 Designation of Facility Responsibility 3. LIC610E Emergency Disaster Plan 4. Proof of $3M liability insurance coverage Deficiency is cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of correction by plan of correction due date and any repeat violations within 12 month period may result in civil penalty. Deficiency and plan and proof of correction were discussed with Rosana Frias. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.