Routine inspection·May 21, 2021

Licensing Program Analyst(s) Mary Flores conducted an unannounced annual inspection visit with focus on infection control domain of the inspection tool, food supply, and medication review. LPA met with Romina Dsouza - Caregiver/Assistant Administrator and explained the purpose of the visit. Administrator, Irene Deanon was called and arrived 30 minutes later. Facility is licensed to serve 6 residents over the age of 60, 6 non-ambulatory of which 6 may be bedridden and has a hospice waiver for 6. Facility is a one story building, with no fences or bodies of water around. Facility serves dementia residents and has auditory devices in exit doors. LPA conducted a physical plant check and observed; 6 resident rooms; all rooms have the necessary furniture, and light, required. 3 bathrooms; all bathrooms (bathroom #1(B1) bathroom #2(B2), bathroom #3(B3)) have soap, paper towel, hand washing signs, skid mats, and grab bars available. Water temperature was read as follow; B1 - 110.1 degrees F. B2 - 110.3 degrees F. B3 - 109.8 degrees F. and sink in hallway 112.6 degrees F. Smog detectors and carbon monoxide detector located in hallways were tested and working. Fire extinguisher observed hanging in the kitchen wall last check on 2/21. Food supplies were review and facility has 2 days of non-perishables and 7 days of perishable for 5 residents. Sharps were locked in drawer, cleaning supplies and disinfectants were locked under sink, and medication was locked in a cabinet next to the pantry. LPA reviewed medication for Resident #1(R1), Resident #2(R2), Resident #4(R4), verified bed rails request for all 5 residents, and TB test for Staff #2 (S2), and Staff #3(S3). Facility was observed following COVID 19 recommendations; staff wearing face coverings, screening done for visitors/staff upon arrival, documentation kept for daily screening and cleaning/disinfecting which is done 3 times a day. Facility staff know isolation procedures and quarantine procedures for both staff and residents. Mitigation plan was submitted to the department on 2/15/21 and waiting for approval. LPA provided a Technical Assistance LIC 9102 regarding N95 Fit testing for staff. Based on California Code of Regulations, Title 22, there were no deficiencies observed during the visit. Exit interview was conducted with Administrator Irene Deanon and a copy of this report and LIC 9102 was provided.