Routine inspection·May 13, 2021

Licensing Program Analysts (LPAs) Ashley Smith and Emily Peraldi arrived at the facility unannounced to conduct a required annual visit at 10:30am. When the LPAs arrived, there was one staff and five residents present. Administrator Kajo Movsesian arrived around 10:45am. 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 that is single latched; however, at 11:01am, the latch was padlocked. The LPAs informed the Administrator that this had to be removed. KITCHEN: The LPAs observed the kitchen/dining area at 12pm. 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 12:05pm, the LPAs observed over-the-counter milk of magnesia in the refrigerator. At 12:07pm, the LPAs observed Lysol on the counter. The staff removed these items 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 12:17pm, the LPA observed that the bathroom in the common hallway was not stocked with paper towels. Technical violation was issued for improper infection control protocol. 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. CONT 809-C 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: - Documenting temperatures for staff and residents - Testing Protocol, to ensure that 25% of staff are being tested weekly - Appropriate signage to remind staff and residents of cough etiquette, visitation policies and procedures, hand hygiene, etc. - Posting Provider Information Notices (PINs) and educating staff, residents, and families on changing policies and procedures from the Department - Identifying and on boarding reserve staff as needed 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.