Routine inspection·July 21, 2022

Licensing Program Analyst (LPA) David Sicairos conducted an unannounced annual visit using the Infection Control Evaluation Tool. LPA met with Assistant Administrator Maria Tavarez and explained the reason for the visit. Administrator Flormine Resurreccion was informed of the visit via phone call. Physical Plant was toured, medications were reviewed, and food supply was inspected. The following was observed/inspected: LPA and Ms. Tavarez toured the home and observed: (4) bedrooms, (2) bathrooms,(1) staff room, living room, kitchen, dining room, and detached garage/laundry room. The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area for the residents located in the backyard. Passageways and exits are free of obstruction. The water temperature was tested in bathroom #1 in the hallway and measured at 110.6F which is within the required 105F - 120F degrees. Grab bars and non-skid mats were observed in the bathrooms. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have sufficient closet space. Resident beds have the required linen and the linen is in good condition. Smoke detectors and carbon monoxide detectors are intertwined and were observed throughout the facility and were tested and operable during the visit. There is a fire extinguisher located near the kitchen which is fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps are locked in a kitchen drawer and are inaccessible to residents. Cleaning supplies and disinfectants are locked under the sink and are inaccessible to the residents. First Aid kit was fully stocked with current manual. Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing. Staff were observed wearing masks and screening visitors at entry. Sufficient supply of 2 days perishable & 7 days non-perishable foods were observed. (4) out of the (4) resident medications were reviewed. Medications are centrally stored in a cabinet in the kitchen. Furosemide 20MG dated 07/09/22 was initialed as given to R1, however medication was still in the bubble pack. Meloxicam 7.5MG dated 07/11/22 was initialed as given to R2, however medication was still in the bubble pack. Staff and Resident files were not reviewed during today's visit. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiency observed during the visit is documented on 809D. Exit interview held and a copy of the report along with appeal rights were provided.