Routine inspection·August 11, 2022

On 8/11/2022 at 10:35 AM, Licensing Program Analysts (LPAs) L. Francisco and P. Watson arrived unannounced to conduct Infection Control Inspection. LPAs met with Administrator, Maria Estavillo and explained the purpose of the visit. During the Infection Control Inspection, LPA toured facility with Administrator 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. Cough/sneeze etiquette 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 are maintained at central location and easily accessible for staff. At 11:45 AM, LPAs reviewed 3 staff records and 3 of 3 have health screening and TB test on file. Facility has a mitigation plan and maintains record of routine screening for residents and staff. THE FOLLOWING DEFICIENCIES WERE OBSERVED: -At 10:45 AM, LPAs observed two perishable orange juice being stored in pantry shelf in the garage. Deficiency cleared during visit. Administrator removed items and discarded it. -At 10:55 AM, LPAs observed R1 and R2 have oxygen in use. However, no oxygen signs were posted. Deficiency cleared during visit. LPAs observed Administrator post "Oxygen in-use" sign at appropriate areas -At 10:58 AM, LPAs observed R1 has 5 oxygen tanks stored inside the bedroom closet without proper stands. REPORT CONTINUES ON 809C Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 8/22/2022: 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 deficiencies were 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 with Administrator. Appeal Rights and a copy of this report provided.