Routine inspection·June 29, 2022

Licensing Program Analyst(s) Mary Flores conducted an unannounced annual visit with focus on the infection control domain, food supplies, and medication. LPA Flores 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, with multiple activity/common areas, a commercial kitchen, and a memory care unit. Fire alarm sprinkle system and fire extinguisher were observed throughout the facility. LPA conducted the tour with Raul Sandoval Maintenance Director and observed the following: Commercial Kitchen was observed to have sufficient food for at least 2 days worth of perishables and 7 days of non-perishables. Sharps and cleaning supplies are not accessible to residents. All common areas have signs posted for social distancing, cough/sneeze etiquette. Memory care unit was observed and the cabinet under kitchen's sink with cleaning supplies was unlocked, cleaning supplies accessible to memory care residents. The following rooms were randomly chosen and observed #103,118,121,207,223,232,308,317,324. Each room has all required furniture, sufficient lighting, and in good condition. A water patch was observed in room #324 LPA was provided a copy of roof work order dated 1/28/22. Resident's bathrooms corresponding to the observed rooms were observed to have skid floors and grab bars, water temperature was tested in each bathroom, water tested between 106.5 - 110.4 degrees F., which is within the required 105-120 degrees F. LPA observed outside room #214 which is currently under quarantine and facility is following infection prevention guidelines. Infection control hand washing signs were not observed in kitchen hand washing station, memory care kitchen sink area, and third floor staff break room. LPA Flores reviewed medication and files for resident #1,#2,#3,#4, #5,#6,#7,#8,#9, residents #3, #8, and #9 were missing medication prescribed by the physician. (CONTINUED LIC 809C) Facility does not handle communication with physician or pharmacist as the family or representative requested to handle all communication, facility has noted on medication sheet that the medication is not available. Files for staff #1,#2,#3,#4,#5,#6 were reviewed. Administrator's certificate was observed # 6007396740 with expiration date: 9/28/21, administrator has copies of documents submitted to the department for renewal. Deficiencies have been noted on LIC 809D per Title 22 Regulations and technical advisory notes were provided during this visit. Exit interview was conducted with Margaret Jay Business Office Manager and a copy of this report, LIC 809D, technical advisories, and appeal rights were provided.