Routine inspection·June 11, 2021

Licensing Program Analyst(s) Mary Flores and Luis Mora conducted an unannounced annual visit focusing on the infection control domain, food supplies, and medication. LPA(s) met with Maria Quizon administrator and explained the reason for the visit. Facility is licensed to served 32 ambulatory residents and 80 non-ambulatory, of which 5 may be bedridden. First floor is cleared for bedridden and there is fire clearance granted for egress exits and fire alarm. There are no large bodies of water in the property. Facility is a 3 story building. Emergency chair was observed in the 3rd floor stairway. Fire alarm system and fire extinguisher were observed throughout the facility. Facility tour was conducted with Maria Quizon the following was observed: Kitchen has sufficient food supplies of 2 days of perishables and 7 days of non-perishables. Refrigerator and freezer kept at the required temperature. Common areas were observed as follow; dinning room had a row of 3 square tables with 3 chairs each which does not follow the current 6 feet distancing recommendation, per administrator up to 3 residents have meals in each table. LPA(s) observed 11 randomly chosen rooms; #107,112,116,120,203,207,223,213,318,328, and . Smoke detectors were tested in the resident's rooms, resident's bathrooms had the proper grab bars, and skid mat, water temperature was tested between 112.1 - 115.3 degrees F, which is within the required range of 105 - 120 degrees F. LPA(s) observed 2 pairs of scissors, and cleaning solutions in resident's room #112. Dementia unit has own dinning/activity room, kitchenette with stove handles removed, LPA(s) observed cleaning products were locked under the sink, door with access to the garden had an auditory device that did not go off as the door was open, Room #120 within the dementia room had a French door accessible to the patio with auditory device that did not go off when door was open. LPA(s) reviewed medications for 8 residents, Resident #1(R1),#2(R2),#3(R3),#4(R4) #5(R5),#6(R6), #7(R7),#8(R8); medication was out of the original bubble pack container for the evening, bedtime, and next morning dose for R1,R2,R3,R4. there was not a 30 day supply of medication for R2, R4, R5, and there were PRN medications without a pharmacy label on the medication for R8 . (CONTINUED 809C) Facility is following COVID 19 screening checks, surveillance testing recommendations, visitation recommendations, during the visit staff #2(S2), and hair stylist vendor were observed with their face covering under their chin which is not wear properly based on CDC recommendations. LPA(s) asked staff #3(S3), and staff #4(S4) regarding disinfecting procedures and requested to see disinfecting spray, S3 did not have disinfecting spray available, and S4 had windex, cleaning solution, S4 stated to clean high touch areas. S4 continued to look for disinfecting and found a bottle in housekeeping cart, there was no disinfecting supplies available in staff's break room. Based on Title 22, Chapter 8 Division 6 deficiencies will be noted on 809D. Exit interview was conducted with Maria Quizon administrator and a copy of this report, LIC 809D, LIC 9102, and appeal rights was provided.