Routine inspection·June 24, 2022

On 6/24/2022 at 12:25 PM, Licensing Program Analyst (LPA) L. Francisco arrived unannounced to conduct Infection Control Inspection. Upon arrival, LPA was greeted by Care Staff, Irene Joseph. Administrator, Meeran Saxena later arrived at 12:40 PM. 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. 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 Social distancing and hand washing posters were observed. Common touched surfaces are disinfected at least once daily. Facility has a 30-day supply of PPEs maintained at central location and easily accessible for staff. During record review, LPA reviewed 3 staff records and 3 of 3 have health screening and TB test results on file. Facility has a mitigation plan on file. THE FOLLOWING DEFICIENCY HAS BEEN OBSERVED At 1:15 PM, during record review and interview, S1 has been employed since March 2022, and no vaccination exemption on file is maintained in accordance to Public Health Order and PIN 22-05.1-ASC At 1:20 PM, during record review, weekly COVID-19 testing is not being conducted for S1 according to Public Health Order on September 28, 2021 and PIN 21-32.1-ASC REPORT CONTINUES ON 809C Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 7/1/2022: 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. Administrator authorized Care Staff, Irene Joseph to sign report. Exit interview conducted with Care Staff. Appeal Rights and a copy of this report provided.