Routine inspection·November 30, 2021

Licensing Programming Analysts(LPAs) Mary Flores and Jewel Baptiste conducted and unannounced visit with focus on infection control, food and medication review. LPAs met with caregiver Elmer Manalang and explained the reason for our visit. Facility is licensed to serve 6 over the age of 60 of which 6 is non-ambulatory and 2 can be bedridden. Hospice waiver approved for 2 residents. Facility is a one story house with a Living room, dining room, kitchen, 4 bedrooms and 3 bathrooms. Facility has multiple fire extinguishers, carbon monoxide detectors with sprinkler system through out the facility. LPAs and administrator toured the facility: Bedrooms #1(R1), #2, #3 and #4 was observed to have all the furnishings of 1 desk, chair, lamp and linens. PRN medication was observed in R1 belonging to resident #4. Bathroom #1 toilet has stains and rings of yellow and brown color. Bathroom #2 shower contained dark stains throughout. Bathroom #3 toilet bedside commode was rusted. Water temperature was tested in Bathroom#1 at 152.3, Bathroom #2 at 155.5 and Bathroom #3 at 145.5, which is not within the required 105-120 degrees F. LPAs toured the kitchen and observed sufficient food supplies of 7 days non-perishables and 2 days perishable. LPAs also observed knives in a drawer to the right of the kitchen's sink and chemical solutions for cleaning and pest sprays were located under the sink and a small drawer without a lock. Medication cabinet was observed unlocked. Medication was reviewed for Residents #1, #2 and #3. Facility was observed not following COVID-19 recommendations of screening staff, residents and visitors. Screening needs to be updated to include all COVID symptoms questions and hand washing guidance's. Upon arrival staff was observed not wearing a face covering, Staff need to get fit tested and facility must provide closed lids trash can. Deficiencies was observed during this visited and noted on LIC809D, per California code of regulations, Title 22. Exit interview was conducted with Caregiver Elmer Manalang and a copy of this report, ,LIC809D and appeals rights was provided.