Routine inspection·May 26, 2021

Licensing Program Analyst (LPA) Yelena Avetisyan conducted an unannounced Required 1year/Infection Control Annual inspection. Upon arriving at the facility at 2:30 pm, LPA observed that the licensee did not have the COVID 19 required signs posted on the front door. LPA was allowed entrance to the facility by a resident, the administrator and staff were on the 2nd floor of the property which is not part of the licensed facility. Upon entering the facility, LPA signed in and the Administrator took LPA’s temperature. Administrator requested for LPA to compete the sign in and document temperature. LPA also observed that other individuals who visited the facility did not records their temperature. The administrator asked the LPA to wait for several minutes while she located the thermometer. The Administrator stated there are four residents at the facility. One of the 4 resident was later identified as a tenant residing in a resident room. Administrator also confirmed all residents and staff have received the COVID-19 vaccine. LPA conducted a tour of the facility with the administrator at 2:40 pm to 3:15 pm which revealed the following. with the administrator. Licensee does not have all the required COVID-postings throughout the facility. Routine symptom screening (+/- temperature and symptom check) has not been initiated at entry for all staff, residents, and visitors. The licensee and staff only do temperature checks. Facility does not document daily temperature and COVID-19 symptom checks, and any change in condition for staff and residents in order to track spread and why facility took certain steps to prevent and mitigate spread in the facility. Licensee does not have procedures for when to test staff, and residents to monitor the spread of the virus and mitigate outbreaks. Per administrator they do not do surveillance testing. Licensee has not provided all staff who are or will be working with COVID-19 positive residents with fit testing for N95 respirators. Licensee has not conducted staff training on infection prevention, symptoms, transmission and PPE use by an individual trained in infection control. Licensee does not have an adequate 30 day supply of PPE Licensee does not have other Department required postings such as the LTCO Poster, Complaint Poster, Emergency Disaster Plan, Personal Rights, Emergency phone number Licensee does not have records for daily resident and staff temperature and symptom checks. KITCHEN: While touring the Kitchen LPA observed it was clean and sanitary. Licensee has sufficient food supply. LPA did not observe hand washing signs posted in the kitchen. RESIDENT ROOMS: While conducting a tour of the residents rooms LPA observed the following. The facility has a total of 5 bedrooms and 3 bathrooms for resident use, however LPA observed total of 7 beds in the 5 rooms. Per administrator room # 1 is being used by staff and room # 4 is being utilized by a tenant. According to the pre-licensing report the facility is fire cleared for 5 non-ambulatory and 1 bedridden. During the pre-licensing visit the department was informed that licensee with have 24 hour awake staff and all the rooms were designated for residents. While touring the room LPA Observed that closet in room # 5 was being used as storage for the licensee. Licensee is also storing the facility PPE supplies in an attic accessible only from room # 5. When LPA entered room 5 a female resident was observed sitting on the couch. Administrator told LPA that the resident was residing in that room, however LPA observed Men's clothing and other items in the room, when questioned further administrator stated that the resident does not reside in the room. LPA also observed the resident exit from the backdoor. Administrator apologized to the LPA for being untruthful. RESTROOMS: Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid mat. Upon initial inspection LPA did not observe soap and paper towels in one of the bathrooms. Administrator requested for staff to immediately place soap and paper towels in the bathroom. OUTDOOR SPACE: While touring the backyard LPA observed that the licensee does not have a covered outdoor area for resident use. Licensee also built and ADU behind the house which is not fenced off. According to the administrator the ADU is being rented to 3 different families. LPA observed that the ADU unit has 3 separate doors for entrance. None of the individuals living in the ADU have received criminal record clearance. Administrator has agreed to submit rental agreements for review and to discuss with management if zero tolerance citation will be issued. LPA also observed that there is a gate behind the property that has been designated as an emergency exit however the gate had a key lock that only the ADU tenants have keys to. At 3:20 pm LPA spoke with LAFD inspector and confirmed that a gate which is designated to provide access to LAFD cannot be locked. At 3:30 pm LPA conducted review of residents records and observed that following Admission agreement for all 3 residents were not SB781 compliant. Physicians report for incomplete for resident 1 (R1) and mission for resident 3 (R3) Licensee is currently retaining a resident who has a diagnosis of Major Neurocognitive disorder without an approved plan of operation. Licensee is not keeping a centrally stored medication and destruction log for 3 out of 3 residents. Licensee does not have PRN authorization logs for residents. Licensee will submit the following to LPA by 5/29/2021. Liability Insurance Rental Agreements for tenants living in the ADU Due to computer issues LPA was unable to issue the report and citation on the day of the visit, however the deficiencies and concerns were discussed with the administrator approximately 4:30 to 5:00 . Report was emailed to administrator for signatures on. 5/27/2021.