Routine inspection·August 10, 2022

On 8/10/2022 at 10:55 AM, Licensing Program Analysts (LPAs) L. Francisco and P. Watson arrived unannounced to conduct Infection Control Inspection. Upon arrival, LPAs were greeted by Care Staff, Imelda Marasigas. Administrator, Pamela Chan later arrived at 11:30 AM. During the Infection Control Inspection, LPAs toured facility with Care Staff, Divine Monis 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. Visitors policy is posted on the front entrance. 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. Facility staff were observed to be wearing proper PPE. PPEs maintained at central location and easily accessible for staff. At 11:50 AM, LPAs reviewed 3 staff records and 3 of 3 have health screening and TB test results on file. Facility has a mitigation plan and maintains record of routine screening for residents and staff. THE FOLLOWING DEFICIENCY WAS OBSERVED DURING VISIT: -At 11:15 AM, LPAs observed orange juice and whipped cream are being stored in the pantry closet. Deficiency cleared during visit. LPAs observed staff removed items from pantry and discarded it. REPORT CONTINUES ON 809C Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 8/19/2022: 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 deficiency by POC date may result in additional Civil Penalties. Exit interview conducted with Administrator. Appeal Rights and a copy of this report provided.