Routine inspection·August 11, 2022

On 8/11/2022 at 1:07 PM, Licensing Program Analysts (LPAs) L. Francisco and P. Watson arrived unannounced to conduct Infection Control Inspection. Upon arrival, LPAs met with Care Staff, Mary Urbano and explained the purpose of the visit. LPAs spoke to Administrator over the phone. During the Infection Control Inspection, LPA toured facility with Care Staff 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. 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. 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. Facility has a 30-day supply of PPEs maintained at central location and easily accessible for staff. At 1:57 PM, LPAs reviewed 2 staff records and 1 of 2 staff have health screening and TB test on file. Facility has a mitigation plan and maintains record of routine screening for residents and staff. 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. Appeal Rights and a copy of this report provided.