Routine inspection·August 3, 2021

Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced annual visit focusing on the infection control domain, food supplies. LPA(s) met with Carlos Lara Executive Director and explained the reason for the visit. Facility is licensed to served 155 non - ambulatory residents, of which 4 may be bedridden and has hospice waiver for 20 residents. . Facility is a 4 story building, with a lobby, dinning room, 2 activity room, a kitchen, a small outdoor shaded patio that is currently under renovation and not accessible to residents, medication room in the second, and a salon in the third floor. Fire alarm sprinkle system was observed throughout the facility. There are no large bodies of water in the property. LPA Flores conducted a walk through with Executive Director and observed the following: Facility is clean and free of odors in common areas observed. Kitchen - Facility has sufficient food of at least 2 days of perishables and 7 days of non-perishables. LPA observed residents lunch hour and there were 2 tables (1 square, 1 rectangle) sitting 4 residents, and other square tables sitting 3 residents which does not follow the recommended 6 feet apart per CDC - COVID 19 recommendations. Elevators are in working condition. LPA choose random rooms to observe and tested water temperature in each room: room #127 tested at 117.4, #118 tested at 116.9, #205 tested at 106.5, #215 tested at 118.7, #227 tested at 116.4, #219 tested at 120, #324 tested at 119.3, #322 tested at 118.2, #315 tested at 113.8, #305 tested at 108.9 #401 tested at 113.1 #407 tested at 118.2 degrees F which is within the recommended 105 to 120 degrees F. All bedrooms have the proper bedding, and furniture. LPA Flores observed the following in rooms #127 lysol wipes and PRN medication, room #227 lysol wipes, #219 ants in bathroom's sink LPA asked administrator to pull the emergency call cord 4 minutes after administrator and LPA walked to medication room to ensure light was on Wellness director stated to have notice light was on but there was no response, and in room # 322 LPA observed 3 empty oxygen tanks. (CONTINUED LIC 809C) Facility has COVID guidelines in place: such as screening of visitors, signs in front lobby, training related to infection control. LPA observed 3 staff; wellness director, a med tech, and activity director not wearing their mask around other staff or residents. Hand sanitizers dispensers are throughout the facility. There are no signs throughout the facility, staff bathroom and kitchen hand washing sink were missing proper hand washing sign. LPA Flores was not able to conclude today's annual visit and will return at a further time to continue annual visit. Deficiencies cited today only reflect infection control domain, other deficiencies were observed were made on other domains and will be address in the next visit. Per Title 22 Regulations Chapter 6 Division 8, deficiencies will be cited for today's visit in attached LIC 809D, technical violation, and Technical Advisory notes will be given. Exit interview with Carlos Lara executive director was conducted and a copy of LIC 809D, tecnical violation/advisory, appeal rights were provided.