Routine inspection·May 24, 2021

Licensing Program Analysts (LPAs) Emily Peraldi and Ashley Smith arrived at the facility unannounced to conduct a required annual visit at 9:43am. When the LPAs arrived, there was two staff and five residents present. Administrator, Lusine Srmikyan arrived around 10:10am. The LPAs toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. OUTDOOR SPACE: The LPAs observed the backyard, which has a covered outdoor area for resident use. There is a gate on the side of the house designated for an emergency exit. KITCHEN: The LPAs observed the kitchen/dining area at 10:33am. Knives are stored in a locked cabinet in the kitchen. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 10:34am, the LPAs observed expired milk in the refrigerator. The staff removed and disposed of the item upon observation. BEDROOMS: The LPAs observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. RESTROOMS: Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid mat. At 10:17am, the LPAs observed Lysol disinfecting spray, over the counter medications and personal hygiene items in the restroom inside Bedroom 1. The staff removed and locked the items upon observation. Records: LPAs requested files for all current residents at 10:49am. Per review of the Physician's Reports, 1 out 5 residents (R1) were identified at being at risk if allowed access to personal grooming and hygiene items. Also, 2 out of 5 residents (R2, R3) need an updated appraisal. Cont. on 809C. INFECTION CONTROL: During today’s visit, the LPAs spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and a sanitation station. The LPAs observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility has not had a confirmed case of COVID-19 at this time; however, the facility’s policies and procedures as it pertains to infection control are adequate. The following recommendations were made: - Reminder to staff - when visitors come in, prompt them to check temperatures, encourage visitors to sign in, etc. Staff did not do this with the analysts upon arrival. - Upon entry, the LPAs observed one staff not wearing a face covering. However, staff immediately complied and put on a covering. A reminder to inform staff that they need to wear face covering throughout entire shift (unless eating/drinking, etc) - Posting Provider Information Notices (PINs) and educating staff, residents, and families on changing policies and procedures from the Department. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.