Routine inspection·June 7, 2022

**** This amended report supersedes report dated 06/07/2022. It was created to insert the correct word to correctly identify the deficiency. "non" was added in from of the word perishable on the Deficient Practice Statement for deficiency number 87555(b)(26) . Revision did not change any other aspects of the report and all aspects remain the same. Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA met with Lizze Cohn,Drcs, in training, Zara Khatchatrian RN, Micelle Sucillion Sales Director, and explained the purpose of the visit. Administrator Mary Jane Rodriguez arrived later and assisted with the inspection. Administrator certificate expires 8/2/2023 Last fire drill was on May 11/2021 Structure: The facility is licensed to serve for a capacity of one hundred sixty (160) Non-Ambulatory residents, of which thirty (30) may be bedridden ages 60 and above. The facility has an approved Hospice Waiver on file for fifteen (15) residents. There are currently fourteen (5) Residents on Hospice. There are currently eleven (1) residents who are bedridden. There are one hundred and ten (105) residents residing in the assisted living portion of the facility and twenty seven (24) residents in the memory care unit. Belmont Village Burbank has an approved Dementia Care Plan in their plan of operation and accepts residents with dementia. Facility is approved for Delay Egress. LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility follows Title 22 Regulations. The first level consists of a dining room, kitchen, memory care unit, bistro, mail room, wellness center and multiple recreation and lounge rooms. The second floor consists of offices, resident apartments and a gym (Center for Life Enhancement). The third floor consists of resident apartments and a Center for Learning. The fourth floor consists of a movie theater, salon and resident apartments. There are laundry rooms located on each floor of the building. Medications are centrally stored in the locked medication stations located on floors one and three. LPA toured a random selection of resident rooms on each floor. Resident rooms were furnished appropriately. Each resident room has their own restroom. The bathrooms were observed to be clean and operational w/grab bars. With the exception of room 219. The resident rooms have a signal system located in each restroom and facility phones to call the front desk. The facility has central air and heating accommodations. The hot water temperature was tested throughout the facility and was not measured within Title 22 Regulations. The following were observed/inspected: · COVID-19 signs are posted at the entrance. Visitors are screened in the main entrance and a log is kept. · LPAs was screened for this visit. · Infection control signs and other COVID-19 signs are posted throughout the facility in the bathrooms, kitchen, and hallway to promote handwashing, cough/sneeze etiquette, and physical distancing. · Facility does not have one designated isolation room due to each resident having private. · 12 client rooms, common areas, bathrooms, and outdoor physical plant was inspected. · Client rooms were equipped with alcohol-based hand sanitizer. · Four (4) centrally stored client medication records were reviewed. · Staff responsible for direct care and supervision were observed wearing masks. · Clients were not observed wearing masks but adhering to public health social distance guidelines. · Sufficient supply of perishable for 2 days was observed but non-perishable foods for 7 days were not observed. · A posted Emergency Disaster Plan was posted but was at facility. · PPE's were observed. · Staff and resident files were not reviewed during today's visit. · Deficiencies cited per Title 22 Health and safety code, See 809D for details. · Exit interview was conducted with Administrator Mary Jane Rodriguez . A copy of the report was provided.