Routine inspection·July 6, 2022

Licensing Program Analyst (LPA) Elsie Campos arrived at the facility unannounced to conduct a required annual visit at approximately 1:45 p.m. This annual had a specific emphasis on infection control practices and procedures. The LPA met with Administrator Susanna Gasparyan and explained the reason for the visit. The LPA 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. KITCHEN: 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. BEDROOMS: The LPA observed four bedrooms, two bedrooms observed were shared and two were private with one containing a private bathroom and the other with an exit to the exterior. All bedrooms were furnished appropriately with clean linens, furnishings, and sufficient lighting. RESTROOMS: Restrooms are clean, sanitary and in operating condition with grab bars and non-skid surfaces. The LPA observed appropriate hand-washing signs. Water temperature measured between 108.1 degrees Fahrenheit and 131.5 degrees Fahrenheit at the time of the visit. Administrator used a personal thermometer which read the temperature from a short distance. Temperatures read within department guidelines however would not register temperature over 120 degrees Fahrenheit. Administrator indicated they would replace thermometer to ensure and accurate reading. Continued on LIC8 09-C COMMON SPACES: Walls and flooring were checked for cleanliness and good condition. Passageways were clean and clear of obstructions. A locked and inaccessible pool was observed in the backyard at the time of the visit. Facility has a designated visitation area located outside under a covered patio area with appropriate furniture and seating for residents. The LPA observed all the required postings in the dining room and the hallway that promoted cough etiquette, signs and symptoms of COVID-19, and appropriate hand hygiene. Medications are kept locked inaccessible in the kitchen area filing cabinet. A medication lock box was observed in the kitchen refrigerator with a key attached and unlocked. Administrator was reminded that medication box is to remain locked and inaccessible at all times. Hand sanitizer was available for staff and resident use. Fire Extinguisher was last bought 5/31/2022. GARAGE: There is an attached garage containing a laundry room, cleaning supplies, additional Personal Protective Equipment (PPE) and incontinence supplies. The garage was locked with a single latch making it accessible to residents with a single turn. The administrator was reminded that it must be kept locked and inaccessible to residents at all times. The administrator indicated that they would use the dead-bolt to ensure that the garage is kept appropriately secured at all times. INFECTION CONTROL: The facility has a central entry point for symptom screening, temperature checks, and sanitation station. The LPA observed an adequate supply of Personal Protection Equipment (PPE). The facility’s cleaning protocol is sufficient. The facility can designate a single isolation room if the facility has a confirmed case of COVID-19. The Administrator continues to conduct testing, regardless of vaccination status. The facility’s policies and procedures as it pertains to infection control are adequate. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): An exit interview was conducted, and Plan of Corrections were reviewed and developed with the Licensee. A copy of this report, LIC 809-D, and Appeal Rights were discussed and provided to Administrator, whose signature on this form confirm receipt of these documents.