Routine inspection·August 24, 2022

Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual required and infection control visit to the above facility. LPA was met with Vicenta Mendoza, Licensee and the purpose of today’s visit was explained. There are currently (3) residents in the facility . (0) residents are ambulatory, (3) are non-ambulatory, () bedridden. The facility is a single-story structure located in a residential neighborhood. It consists (3) bedrooms, (2) bathrooms, shaded back yard, front yard, fountain in front yard not being used, laundry room, and an attached garage. LPA and Oscar toured the entire facility inside and out. Documents are posted as mandated. Bedrooms 1& 2 are occupied by residents and contain the mandated furniture. Bedroom 3 is vacant. The (2) bathrooms are operational but need to be de-cluttered. Bathroom #2 shower is not used and is being as a storage for diapers, toxins, and boxes. Bathroom #1 is operational , but needs to be de-cluttered: it has too many shower chairs and mobile toilets and mobile toilets are dirty. Kitchen table is full of papers, no room to eat. First aid kit is fully stocked with manual; smoke detectors and carbon monoxide detector were in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. (1) Resident file along with medications are current. (1) Staff file is current. Ample supply of perishable and nonperishable food, hot water temperature is 105.6 degrees Fahrenheit, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents, (1) fire extinguisher is fully charged. Exit, walkways and/or passageways have debris: west side passageway of facility contains, broken wood door, paints cans, trash bags, pots, bricks, umbrellas, mini pool, mop cans, which need to be removed. East side passageway has more debris: it's being as storage for licensee, items must be removed and/or stored. Front and back yard are free of debris and/or hazards. The facility is in good repair. During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry & visitors and temperatures are logged and checked, sanitizer/soap, paper towels, in all the bathrooms and additional sanitation supplies are stored in cabinet near living room. LPA observed staff wearing masks, resident private rooms will be converted to isolation rooms (if needed) trash cans with lids, cart for PPE’s, No mitigation plan posted and/or in binder, No Fit testing completed for staff, and required postings throughout the facility. Visitor designated area, facility has internet & computer for residents to use, resident’s temperatures are checked and logged (once a day). Emergency contacts updated and posted; PPE's are enough for 30 days. A ccording to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA observed the following deficiency and issued citations. Technical Advisories (TA) issued. No mitigation Plan posted and/or in binder, No Fit Testing completed for staff. A exit interview was conducted with Vicenta Mendoza, and a hard copy and Appeal Rights provided