Routine inspection·September 28, 2021

On 9/28/2021 at around 10:00 AM, Licensing Program Analyst (LPA) Leslie Ibo conducted an infection control annual inspection and explained the purpose of the visit with Shirley Virden. LPA observed 6 residents during the visit. 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. Pathways were observed to be free of obstruction and fire hazards. Carbon monoxide and smoke detector was observed to be operational. Facility room temperature was maintained at 70 degrees Fahrenheit. There was at least 7 days of nonperishable and 2 days of perishable foods. Infection control designated leader is the staff Noah Lake. A certified Administrator is on site a minimum of 20 hours a week to oversee proper business operation. Continued on next page LIC 809-C LPA observed the following: · Facility DO NOT have adequate 30-day supply of PPE, LPA observed there is only 1 box (20 pcs.) of N95 available during the visit, LPA provided technical assistance. (see notes on LIC812). · LPA observed sharp container, disinfectant spray & eye drops medication accessible to dementia residents in care. Corrected 9/28/2021. · LPA observed facility garage that food supplies were stored together with toxic substances. 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 Shirley Virden and Noah Lake. Exit interview conducted and a copy of this report & appeal rights provided to Administrator.