Routine inspection·October 14, 2021

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit at 11:28 a.m. LPA was greeted and screened by staff. This annual had a specific emphasis on infection control practices and procedures. At 11:48 a.m. LPA and Administrator began the physical plant tour inside and outside to ensure there are no health and safety hazards and facility is in compliance with the Title 22 Regulations. OUTDOOR SPACE: LPA observed the side and front lot, which has a covered outdoor area for resident use. There is an open gate at the front of the facility. KITCHEN: At 11:51 a.m. LPA observed the kitchen/dining area. Knives are stored in the locked kitchen. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Emergency food and water are located in a storage room. At 11:55 a.m., LPA observed staff preparing food in the kitchen. BEDROOMS: LPA observed multiple resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Passageways were free and clear from obstruction. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skids mats. At 12:06 p.m. LPA observed hot water to be measured at 140.2-degree Fahrenheit. Administrator observed the hot water temperature and requested maintenance to set the hot water no more than 120-degree Fahrenheit. At 2:04 p.m. LPA observed hot water temperature to be measured at 106.1-degree Fahrenheit. Continued on LIC 809C. Continued from LIC 809 COMMON AREAS: At 12:00 p.m., LPA observed common areas to be relatively clean and properly furnished. LPA observed staff cleaning common areas and hallways on both the first and second floor. At 11: 59 a.m. LPA observed fire extinguishers throughout the facility hallways on both floors and all were last serviced on 10/21/2020. At 12:14 p.m. Administrator provided a copy of the Fire Alarm inspection report from 7/27/2021 indicating that the Fire Alarms passed inspection. Medications and first aid kits are in a locked medication room located on the ground floor. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away in the maintenance room. INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and a sanitation station. The LPA observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility has not had a confirmed case of COVID-19 at this time; however, the facility’s policies and procedures as it pertains to infection control are adequate. Between 11:30 a.m. - 2:00 p.m., LPA conducted Infection Control mitigation module with Administrator. The following deficiency was observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided via email.