Routine inspection·June 1, 2023

Licensing Program Analyst (LPA) Elsie Campos arrived at the facility unannounced to conduct a required annual visit. LPA Ascencio met with Administrator Arlene Ceballos at 10:15 a.m. and explained the reason for the visit. The LPA toured the physical plant areas inside and outside, with Administrato rArlene Ceballos at 10:25 a.m., to ensure there are no health and safety hazards. BEDROOMS: There are (6) six bedrooms designated for resident use and (1) one bedroom designated for staff use. Bedroom #3 Bedroom #4 and Bedroom #5 have a direct exit to the exterior. The facility has furnished each room with clean linens, appropriate furnishings, and sufficient lighting for resident use. RESTROOMS : Resident restrooms are clean, sanitary, and in operating condition with grab bars and non-skid surfaces. The LPA observed sufficient amounts of soap and paper products. The restrooms hot water measured between 105.0 and 120.0 degrees Fahrenheit. KITCHEN: Kitchen appliances were in operable conditio n. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The facility has a sufficient supply of perishable and non-perishable food. Knives, medications, and chemicals were locked and inaccessible. Kitchen sink hot water measured 118.2 degrees Fahrenheit. Continued on LIC 809-C COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, common seating area and dining room furniture was observed to be in good condition. Chairs were observed to be at least 6 (six) feet apart for social distancing. The LPA observed the required postings in the common hallway. Fire extinguishers were observed to be serviced within the last year. The facility smoke alarm system is hardwired and operated normally at the time of visit. Medications were observed to be locked in a closet by the kitchen and contained at least 30 days of worth of medication. The backyard has a covered outdoor area equipped with furniture for resident use. There were two water fountains noted. Both fountains are surrounded with plants and lawn ornaments which make the fountains inaccessible. The LPA observed a storage unit containing additional incontinent supplies, personal protective equipment, and seasonal decorations. INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the facility had a central entry point for symptom screening, temperature checks, and sanitation station. The LPA 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 does not have a confirmed case of COVID-19 at this time. The facility’s policies and procedures as it pertains to infection control are adequate. 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. At 11:30 a.m., during resident file review, LPA observed 5 out of 6 residents did not have their Appraisal or Reappraisal signed by resident representative. At 11:40 a.m., during resident file review, LPA observed 1 resident file that did not have a Tuberculosis exam results. Continued on LIC 809 - C At 11:47 a.m., during record review, LPA observed 2 staff files that did not have a completed Health Screening Form and their Tuberculosis exam results. At 1:30 p.m., during medication audit, LPA did not observed Acetaminophen 325 mg to be at the facility for resident per doctor's order. Exit interview conducted and copy of the report and appeal rights were issued to Administrator.