Routine inspection·May 16, 2022

On 5/16/22 at 2:00 PM, Licensing Program Analyst (LPA) L. Francisco arrived unannounced to conduct Infection Control Inspection. Upon arrival, LPA was greeted by Care Staff, Berona Bronn. Administrator, Mona Eweda later arrived at 2:20 PM. During the Infection Control Inspection, LPA toured facility with Administrator 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. 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 bin with touchless lids. During record review, LPA reviewed 3 staff records and 1 of 3 have health screening and TB test on file. Facility has a mitigation plan. THE FOLLOWING DEFICIENCIES WERE OBSERVED: At 2:52 PM, LPA observed staff are not fully vaccinated and does not have an exemption on file. In addition, weekly COVID-19 testing is not being conducted. At 3:30 PM, LPA observed S1 is not fingerprint cleared. At 3:32 PM, LPA observed S1 and S2 does not have health screening and TB test on file. REPORT CONTINUES ON 809C Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 5/20/2022 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 deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies by POC date may result in additional Civil Penalties. A Civil Penalty of $500 is being assessed. Exit interview conducted. Appeal Rights and a copy of this report provided.