Routine inspection·January 18, 2022

On 1/18/2022 at 10:15AM, Licensing Program Analyst (LPA) Leslie Ibo conducted an infection control annual inspection and explained the purpose of the visit with S2, LPA called licensee Maria Niduaza . Licensee Maria arrived at the facility around 10:30AM. LPA observed 4 residents during the visit. Facility has approved 6 hospice residents and currently have 3 hospice residents. Facility has a completed mitigation plan. LPA inspected the facility inside and outside. LPA observed COVID-19 signage posted in common areas to promote hand washing, cough/sneeze etiquette and physical distancing. LPA inspected the physical plant, but not limited to the kitchen, dining area, resident's bedrooms, bathroom, laundry room, and backyard. LPA observed there is enough furniture and lighting throughout the facility. LPA observed there is a seven day non-perishable and two-way perishable food supply, and cleaning supplies and toxins were locked. The smoke detectors and carbon monoxide detectors are in compliance with fire safety. Infection control designated leader Maria Niduaza & Liezyl Ajos. Continued on next page LIC 809-C LPA observed the following: · Licensee has not provided all staff with fit testing for N95 respirators. · Current Administrator and back up Administrator (S4) has expired administrator certificate. Deficiencies are cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of corrections by plan of correction due dates, and any repeat violations within 12-month period may result in civil penalties. Deficiencies and plan and proof of corrections were discussed with Maria Niduaza. Exit interview and appeal rights conducted and a copy of this report provided.