Routine inspection·November 19, 2022

On 11/19/22, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit with a primary focus on Infection Control measures using the CARE Inspection Tool. LPA met with administrator Kenneth Soleta and explained the purpose of today’s visit. The facility is licensed to operate for six (6) elderly residents and cleared for (4) non-ambulatory and (2) bedridden ages 60 and above. The facility is approved for one (1) hospice resident. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) residents' rooms, one (1) bathroom, a living area, a dining area, a kitchen, and an outside covered patio area. LPA toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of the visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 115.4 F. A comfortable temperature of 73 degrees was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available and maintained properly. The facility has one (1) fire extinguisher that was charged, and smoke detectors and carbon monoxide were operable. LPA reviewed Medication Administration Records (MAR) revealed to be accurate and maintained in order. The facility conducted a Fire/Safety Drill on 10/03/22. A working landline telephone remains available. The facility has current liability insurance effective 07/13/22 - 07/13/23. Evaluation Report Continues on LIC 809-C INFECTION CONTROL: During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed staff wearing face coverings, LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. A review of the resident's and staff vaccination records were conducted. The facility has a Mitigation Plan Report on file with CCLD. All staff had current (CPR/First-Aid) training certificates. DEFICIENCIES: Based on interviews, observation, and record reviews, LPA identified a staff # (S3) without Criminal Record Clearance from the State of California. (S3) had a Criminal Record Clearance from the state of Arizona which is not valid. LPA identified residents #1-#3 with dementia who did not have ongoing/annual appraisals on file. Deficiencies are cited on LIC 809D. An exit interview was conducted and a copy of this report was provided to Kenneth Soleta.