Routine inspection·August 3, 2022

On 8/3/2022 at 09:25AM, Licensing Program Analyst (LPA), L. Hall arrived unannounced to conduct a 1-year annual infection control inspection. Upon arrival LPA rang doorbell that is located outside of locked entry gate. LPA called facility 3xs and the voicemail box was full. LPA was able to see a recycling bin outside of facility. No cars were present. LPA was able to peak through fence and saw the blinds were open. LPA will attempt visit at a later date. On 8/11/2022 at 11:25AM, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct an Infection Control Inspection. LPA met with Levi Villareal, Administrator and explained the purpose of the visit. Upon entry, LPA's temperature was not checked. LPA observed screening station and COVID-19 signs posted near screening station. LPA toured facility including but not limited to common areas, bathrooms, bedrooms, kitchen, garage and back yard. All hand washing stations were equipped with soap and paper towel. Hand washing posters were posted at hand washing stations. Hot water temperature in the shared clients’ bathroom was measured at 116.2 degrees Fahrenheit. Fire extinguisher last serviced on 7/19/2019. There is a minimum of 7-day non-perishables and 2-day perishables foods. Continued on LIC809C. Continued from LIC809. During record review, LPA observed facility has a copy of the mitigation plan on file. LPA observed food and paper supplies are sufficient. The following deficiencies were observed: -At 10:42AM, LPA observed Ajax, windex, and raid in unlocked cabinet under kitchen sink. -At 11:55AM, LPA observed R1 on hospice care. Facility does not have hospice waiver. -At 12:05PM, LPA observed while reviewing R1's file that the file is missing the following documents: personal rights, personal safeguard, Identification and emergency information, and a care plan for hospice services. The following documents are outdated appraisal needs and services plan, and physician's report. -At 12:15PM, LPA observed that Administrator certificate expired on 2/19/2022. -At 12:20PM, LPA observed that Administrator was not following requirement duties for Administrator. LPA request the following documents to be submitted to CCLD by 8/18/2022. LIC 500 Personnel Report LIC 610E Emergency Disaster Plan The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in Civil Penalties. Exit interview conducted. A copy of this report provided and appeal rights provided.