Routine inspection·October 6, 2022

On 10/6/2022 starting at 10:55 AM, Licensing Program Analysts (LPAs) L. Francisco and L. Alexander arrived unannounced to conduct Infection Control Inspection. Upon arrival, LPAs were greeted by care staff, Gilbert David and LPAs explained the purpose of the visit. Back-up Administrator, Jaidi Smith later arrived at 11:30 AM. During the Infection Control Inspection, LPAs toured facility with Back-up 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. 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 minimum 30-day supply of PPEs maintained at central location and easily accessible for staff. At 12:10 PM, LPAs reviewed a sample of 2 staff records and 2 of 2 staff have TB test results on file. Facility has a mitigation plan and maintains record of routine screening for residents and staff. REPORT CONTINUES ON 809C THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 11:05 AM during record review, LPAs observed S1 is fingerprint cleared. However, S1 is not associated to the facility At 11:45 AM, LPAs observed rubbing alcohol and DayQuil being stored in an unlocked kitchen cabinet. Deficiency cleared during visit, LPAs observed care staff removed items and locked it away. At 11:55 AM during record review, LPAs observed S1 and S2 does not have a complete health screening on file signed by a physician. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 9/14/2022: 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. Appeal Rights and a copy of this report provided.