Routine inspection·December 4, 2022

Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual required and infection control visit to the above facility. LPA was met with Ivan Bravo, Administrator and the purpose of today’s visit was explained. There are currently (2) residents in the facility. (2) residents are ambulatory, (0) are non-ambulatory, (0) bedridden. The facility is a single-story structure located in a residential neighborhood. It consists (4) bedrooms, (3) full bathrooms, living, room, dining, kitchen, shaded back yard, front yard, and laundry room inside the detached 1 car garage. LPA and Administrator toured the entire facility inside and out. Documents are posted as mandated. Bedrooms 1-3 are occupied by residents and contain the mandated furniture. Bedroom 4 is a staff bedroom. The (2) bathrooms have grab bars and non-skid mats and are clean and operational. 3rd bathroom is a staff bathroom. First aid kit is fully stocked with manual; smoke detectors and carbon monoxide detector were in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. (1) Resident file was current and medications were not current (doses missed- 1 pkg (gabapentin 100mg zolpiem 5mg - 2days missed) 1 pkg- (Buspirone 5mg Dicyclomine 10mg - 1 day missed): 1 pkg - (Gabapentin 100mg dicyclomine 10mg Buspirone 5mg - 1 day missed). (1) Staff file was not current (CPR card expired 2018). Ample supply of perishable and nonperishable food, hot water temperature is (120) degrees Fahrenheit, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents, (2) fire extinguisher is fully charged. The facility is in good repair. During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry & visitors and temperatures are logged and checked, sanitizer/soap, paper towels, in all the bathrooms and additional sanitation supplies are stored in the back porch. LPA observed staff was not wearing masks. resident private rooms will be converted to isolation rooms (if needed) trash cans had no lids, no cart for PPE’s, mitigation plan posted and/or in folder, NO - Fit testing completed for staff, and required postings throughout the facility. Visitor designated area, facility has internet & IPhone for residents to use, resident’s temperatures are not checked or logged. Emergency contacts updated and posted; PPE's are enough for 30 days. All residents and staff are vaccinated and boosted According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time. Technical Advisories (TA) issued. 1. Staff must wear masks. 2. Need trash cans with lids in restrooms. 3. Need Cart with wheels for PPE's. 4. No Fit testing for staff, must be completed. 5. Residents temperatures must checked at least once a day. An exit interview conducted with Ivan Bravo, Administrator and a hard copy of report provided.