Routine inspection·March 1, 2022

On 3/1/2022 at 12:30 PM License Program Analyst (LPA) Hansen arrived unannounced to conduct an annual required 1-year infection control inspection visit of the facility. LPA was welcomed by staff Marie Rivera. Administrator Linda Mahlman. There is a total of 8 residents at facility,there are no residents on hospice or have dementia at this time. At approximately 12:45 PM, LPA toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a visible area. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Toxins are stored in a secure room off of the kitchen. Hot water temperature measured between 124.7 degrees F and 125.2 degrees F falling out of Title 22 acceptable regulation of 105 to 120 degrees F in 2 of 4 resident’s bathroom faucets. Fire extinguishers inspected were charged on 5/24/2021. Smoke detectors were in working order. Facility has fire sprinklers throughout. Fire suppression system was last inspected June, 2020. Carbon Monoxide detectors were checked and in working order. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure in locked cabinets in room area behind kitchen/office. Infection Controle: Facility has submitted a mitigation program plan that has been approved, on 1/27/2021. All staff and visitors check in and log temperatures and either have proof of vaccination on file or show proof of a negative COVID test within the last 72 hours. Posters have been placed at facility. Facility has PPE supply stored in dinning room cabinet, dresser in front hallway and in pantry. Facility has a 30-day supply of medication for residents. Staff had all PPE training required as well have been N95 Fit Tested. All staff have been fully vaccinated and received their COVID booster shots and all staff work exclusively at this facility. Continued on LIC809-C.. . In addition, facility has designated areas for visitors in bedrooms (they are all individual) and other areas which are being allowed for visits. Residents also have available zoom, facetime, and telephone calls when contacting with family members and others and assistance if needed. Facility has not conducted a disaster drill in the last 2 years. LPA reviewed Licensing Information System (LIS) with designee who stated that is correct and updated at this time; no need to change any of the information other than add Licensee’s cell number. LPA advised facility to contact Local County Public Health and DSS/CCL Community Care Licensing immediately if symptoms or COVID-19 + in the facility. LPA was informed by Licensee no staff have current CPR & or 1 st Aid certification. Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided. LPA Hansen is requesting Licensee to update and submit the following documents by 3/15/2022 to RPRO: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 610E-S Supplemental Emergency Disaster Plan LIC 9020 Register of Facility Resident’s Copy of Administrator Certificate Proof of Liability Insurance