Routine inspection·September 13, 2022

On 09/13/2022 at 02:20 PM Licensing Program Analysts (LPAs) L. Holmes and M. Malik conducted an unannounced annual infection control inspection. LPAs met with Medication/Floor Staff, Jiena Guien and informed the purpose of visit. LPA L. Holmes spoke to Administrator Norma Tejero and Licensee Juliana Taburaz; both could not be present.Per LIC308, Jiena Guien can sign the report. Facility has a completed COVID-19 mitigation plan and submitted to Community Care Licensing (CCL). LPAs inspected the facility inside and out with staff. LPAs observed screening station located near the front entrance with visitor's log, hand sanitizer, gloves, masks, and no touch temperature probe. 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. LPAs observed COVID-19 signages posted all throughout the facility. Medications are centrally stored in the a locked room. Centrally stored PPEs were unable to be inspected. There were at least 7 days of nonperishable and 2 days of perishable food supplies that were questionable in amount. The Cook stated that groceries are purchased twice a week and a new deliver is for 09/14/2022. Fire extinguisher was observed fully charged and tag showed serviced November 12, 2021. Smoke and carbon monoxide detectors were operational. First aid kit inspected and observed complete with manual. Hot water temperature in the common bathroom tested and measured at 93.4 degree Fahrenheit (F). .......continued on 809C ...continued from LIC809 The following forms are to be updated and submitted to CCLD: 09/27/2022 -LIC500 Personnel Report -LIC308 Designation of Administrative Responsibility -LIC610 Emergency Disaster Plan -An updated copy of Administrator Certificate(s) LPAs observed the following during course of inspection: · Approximately at 3:05 PM, LPAs observed sink areas without paper towels in the staff room, staff meeting room #2. · Approximately At 3:10PM, LPAs observed Care Staff did not have access to all stored PPE. PPE was locked in Room #6. · Approximately at 3:11 PM, LPAs observed cobwebs, a hanging orange towel, uncovered garbage can in shared sink and toilet area of rooms #14 and #!5. #17 did not have paper towels. · Approximately at 3:16 PM, LPAs observed 5-6 PPE gowns in room #19. · Approximately at 3:21 PM, LPAs observed shower room #1, broken uncovered garbage can, sink faucet did not have hot and cold water fixtures, a black hose about 3 feet long in place of a shower hose and head fixture. One shower stall has an out-of-order sign. · Approximately at 3:22 PM, LPAs observed room #23 with brown faux wood floors buckling in 4-5 places. Brown, left cabinet door to the sink vanity is off the hinges and missing. White vertical window blinds missing vertical pieces and in disrepair. · Approximately at 3:27 PM, LPAs observed uncovered garbage cans in hallway of room #26 and #29. continued on LIC809C... ...continued from LIC809C · Approximately at 3:37 PM, LPAs observed silver metal grab bar in the bathroom of room #32, unscrewed and separating from the wall, out of order sign was taped to the bathroom door, and white vertical window blinds missing vertical pieces and in disrepair, and one door of the two closet doors was off the hinges and propped against the wall near the bedroom entrance door. · Approximately at 3:33 PM, LPAs observed dining area; hand washing signs, paper towels and covered garbage cans are needed. · Approximately at 3:47 PM, LPAs observed shower room #2, what appeared to be mold/mildew on the floor and wall tile fixtures throughout the shower area. · Approximately at 5:10 PM, LPAs tested water temperature at shower room #2 at 68.6 degrees (F) · Approximately at 5:12 PM, LPAs tested water temperature at the shared sink near room #26 at 93.4 degree (F) · Approximately at 6:10 PM, LPAs observed staff toilet in the staff meeting room #2 does not flush. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct these deficiencies and/or repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. Copy of report and appeal rights provided to Jiena Guiem.