Routine inspection·May 14, 2021

Licensing Program Analysts (LPAs) Ashley Smith and Sandra Urena arrived at the facility unannounced to conduct a required annual visit 9:35am. This annual had a specific emphasis on infection control practices and procedures. The LPAs met with Administrator Nirvana Ghaemi and explained the reason for the visit. The LPAs, with the guidance of staff, 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. BEDROOMS: The LPAs observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are six bedrooms for resident use; however, Room #4 and Room #6 are currently occupied as staff rooms. At 9:55am, the LPAs observed Room #3. There were accessible medications observed in the room. RESTROOMS: Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. During the visit, the LPAs did not observe signage in any of the bathrooms pertaining to proper hand hygiene. In addition, at 9:59am, the LPAs observed accessible disinfectant in the bathroom. This item was properly secured upon observation. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a temperature of 73 degrees. All exits have functioning auditory devices; however, at the time of the visit, they were turned off. The LPAs observed the required postings in the common area; however, the facility did not have the Department complaint poster. The backyard has a covered outdoor area equipped with furniture for resident use. The side gate door is self-latching. Although it was not locked during today’s visit, the LPAs observed a padlock by the door. The Administrator was reminded that the side gate cannot be locked. There were no bodies of water noted. The garage is detached from the home. KITCHEN : Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable food; however, the facility does not have a sufficient seven day supply of non-perishable food. In addition, the LPAs observed produce in the fridge and freezer that were left open and improperly packaged. 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 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: - 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 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.