Routine inspection·November 30, 2021

Licensing Programming Analysts(LPAs) Mary Flores and Jewel Baptiste conducted and unannounced annual visit with focus on infection control domain, food and medication review. LPAs met with Leo Del Rosario and explained the reason for the visit. The facility is licensed to serve 44 residents over the age of 60 of which up to 18 may be non-ambulatory residents, is approved for 4 hospice waivers, and 6 bedridden in assigned rooms. Facility is a two story building with a kitchen, dining room, library/ laundry room, activity room, 2 common bathrooms, 2 staff bathrooms, 1 resident shared shower room down stairs, residents bedrooms with private bathrooms and a medication room. Facility has multiple fire extinguishers and carbon monoxide detectors with a sprinkler fire system throughout the facility. LPAs and administrator toured the facility which included: random bedrooms which include room # 81, 84, 88, 65 and 68. All rooms were clean, odor free and had the required furniture of one desk, chair, dresser, lamp and linens. Bathroom were clean, toilets and water faucets worked properly and have the required grab bars and skid mats. Water temperature was tested the residents bathrooms and it was tested between 108.7 and 115.7 degrees F, which is within the required 105 - 120 degrees F. LPAs observed mold in shower chair of the facility common shower. Facility has operational emergency pull alarms in the resident bathrooms and bedrooms. LPAs toured the kitchen and observed sufficient food supplies for at least of 7 days of non-perishable and 2 days of perishable. LPA observed water damage in medication room approximately 2 x 3 feet. Medication was reviewed for residents #1 and #2. Facility is following COVID 19 recommendations of daily screening for staff, residents, and visitors. Signs are posted throughout the facility. Staff have been fit test for N95s. The facility has sufficient PPE supplies for at least 30 days. Deficiencies were observed during the visit and noted on LIC 809D, Per California Code of regulations, Title 22. Exit interview was conducted with Leo Del Rosario administrator and a copy of the this report, LIC 809D, and appeals rights were given.