Routine inspection·April 29, 2022

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual visit at 11:35 a.m. This annual inspection had a specific emphasis on infection control practices and procedures. The LPA met with Administrator Nirvana Ghaemi, and explained the reason for the visit. The LPA, with the guidance of the Administrator, 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: 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. At 11:50 a.m., the LPA and the administrator observed the kitchen knives to be stored in an unlocked cabinet drawer to the left side of the stove 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 12:15 p.m., the LPA and the administrator observed in Room #6 one bottle of medication located in the left hand side of the closet. The bedroom #6 was unlocked and the closet dore was open. RESTROOMS: Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. During the visit, the LPA did not observe signage in bathroom #2 pertaining to proper hand hygiene. Proper signage and paper towels were promptly displayed. 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 front and rear door leading to the back yard were turned off. The LPA observed the required postings in the common area. The backyard has a covered outdoor area equipped with furniture for resident use. The side gate door is self-latching. There were no bodies of water noted. The garage is detached from the home. RECORD REVIEW: During today's visit, at arrival at 11:35 a.m., S1 was observed to be working at this facility. During todays’ visit at 12:30 p.m., it was observed that Staff #1 (S1) was not associated to the facility, and a file for S1 was not available. Per the interview with S1, S1 stated that they had been working at the facility for one week. A civil penalty was issued on 04/29/2022, noting that S1 could not return to the facility until the background check and association to the facility was complete. The LPA reviewed the Caregiver Background Check System during today’s visit and observed that S1 was not associated to this facility. Per the staff schedule, S1 worked on 12/17/2021, 12/18/2021, and today, 12/21/2021. 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 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 was conducted. A copy of the report and appeal rights were provided.