Routine inspection·May 23, 2022

On 5/23/2022 starting at 10:05 AM, Licensing Program Analysts (LPAs) L. Francisco and L. Fici arrived unannounced to conduct Infection Control Inspection. LPAs met with Executive Director Kirsten Korfhage and explained the purpose of the visit. During the Infection Control Inspection, LPAs toured facility with Executive Director including but not limited to front entrance, screening station, hand washing stations, random residents apartments, common areas, multiple activity rooms, kitchen and courtyard. Facility has a sufficient 2-day perishable and one week non-perishable food supply. Visitors policy is posted on the front entrance. A sign-in policy, thermometer and hand sanitizer were observed at screening station. Common touched surfaces are disinfected at least once daily. Bathrooms are equipped with liquid soap, paper towel and trash bin with touchless lids. Facility staff were observed to be wearing proper PPE. Facility has a 30-day supply of PPEs maintained at central location and easily accessible for staff. At 11:10 AM, LPAs reviewed 6 staff records and 4 of 6 staff have health screening and TB test records on file. Facility has a mitigation plan and maintains record of routine screening for residents and staff digitally. THE FOLLOWING DEFICIENCY WAS OBSERVED DURING VISIT At 11:35 AM during record review, LPAs 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 6/3/2022: 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 deficiency was 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. Exit interview conducted. Appeal Rights and a copy of this report provided.