Routine inspection·May 18, 2021

Licensing Program Analysts (LPAs) Kelly Dulek and Sandra Urena arrived at the facility unannounced to conduct a required annual visit at 11:45AM. This annual had a specific emphasis on infection control practices and procedures. The LPAs initially met with facility staff/designee Vergouhy (Virginia) Nazarian and discussed the reason for the visit. Administrator Annie Osborn arrived at 12:26PM. The LPAs, along with facility designee Virginia Nazarian, 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 4 (four) total bedrooms; 3 (three) are for resident use and 1 (one) is designated as a staff room. During today’s visit, LPAs observed Resident #1 (R1) using Resident #2 (R2) and Resident #3 (R3)’s bedroom as a passageway to the backyard. RESTROOMS: Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. 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 LPAs observed the required postings in the common area. The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water noted. The garage was observed locked and contained the laundry area, as well as emergency food supply, and storage. The side gate is not currently self-closing/latching, and 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 and the lock was removed during the visit. LPAs observed the ramp exiting the back sliding door has a broken threshold, creating a trip/fall hazard. The ramp leading outside from bedroom #3, Report Continued on LIC 809-C which is designated for non-ambulatory and bedridden use, was observed to have severe damage, with broken pieces and exposed nails. KITCHEN : Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. 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, however the facility is not currently allowing visitors. Additionally, LPAs observed 3 (three) staff all working in common areas and not wearing face coverings. Staff did put on masks during the visit. The LPAs observed an adequate supply of Personal Protective 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 resident 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: - Visitors should be allowed, per the guidance in Provider Information Notice (PIN) 21-17-ASC - Face coverings should be worn by residents in common areas of the facility. All staff should wear a face covering while working in the facility and in all facility common areas. - Post PINs and educate 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 via email.