Routine inspection·May 12, 2022

On 05/12/2022 at 2:20 pm, Licensing Program Analyst (LPA) C. Fowler and arrived unannounced to conduct an Infection Control Inspection. LPAs met with Administrator, Obed D'Autruche and explained the purpose of the visit. Upon entry, LPA observed screening station that contained hand sanitizer and thermometer and COVID signage. LPA toured facility including but not limited to common areas, bathrooms, bedrooms, kitchen, garage and backyard. All hand washing stations were equipped with soap, paper towel, and hand washing posters. During record review, LPA did not observed visitors log and temperature logs for residents or staff. LPA observed facility has a copy of Mitigation Plan and provided LPA with a copy via email. The following deficiencies were observed during the visit: -At 2:44pm, LPA observed a pair of scissors on the piano bench located in the living room. -At 2:52pm, LPA observed a knife on top of the stove in the kitchen unlocked, knives are kept in unlocked drawer. -At 2:53pm, LPA observed All laundry soap, Downy fabric softener, bleach, Pine clean, Lyson spray, Fauloso, Windex, WD-40, and Mr. Clean in a unlocked laundry room. -At 2:59pm, LPA observed a rake, garden tools, bed rails, 2 ladders located in the back yard. Continued on LIC809C. Continued from LIC809 The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations. Failure to correct deficiencies by POC date may result in additional Civil Penalties. Request updated documents The following forms are to be updated and submitted to CCLD by 5/19/2022. -LIC500 Personnel Report -LIC308 Designation of Administrative Responsibility -LIC610E Emergency Disaster Plan ARF LIC610D Exit interview conducted. A copy of this report and appeal rights provided.