Routine inspection·September 1, 2022

Licensing Program Analysts (LPA's) Ana Soto and Wendy Gibbs conducted an unannounced Annual required and infection control visit to the above facility. LPA's were met by Marylou Convocar, Care Giver and the purpose of today’s visit was explained. There are currently (1) residents in the facility . (1) residents are ambulatory, (4) are non-ambulatory, (1) bedridden. The facility is a single-story structure located in a residential neighborhood. It consists (6) bedrooms, (2 1/2) bathrooms, mini outside ramps on all exit doors, egress system, back yard, front yard, shaded side patio, laundry room in attached 2 car garage. LPA's and Marylou toured the entire facility inside and out. Documents are posted as mandated. Bedrooms 1-5 are occupied by residents and contain the mandated furniture. Bedroom 6 is a staff bedroom. The (2 1/2) bathrooms have grab bars, non-skid mats, and/or chair and are clean and operational. 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 was not current, CPR card expired 08/15/22. Ample supply of perishable and nonperishable food, Stove top knobs do not automatically light burners, staff using lighter to light burners, hot water temperature is (112.7) 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, 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 the garage. LPA observed staff and residents wearing masks, resident private rooms will be converted to isolation rooms (if needed) No trash cans with lids, cart for PPE’s, mitigation plan posted and/or in folder, No fit testing completed for staff, and required postings throughout the facility. Visitor designated area, facility has internet & IPhone for residents to use, resident’s temperatures are checked and logged (twice a day). Emergency contacts updated and posted; PPE's are enough for 30 days. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA observed the following deficiency and issued a citation. Technical Advisories (TA) issued: 1. No trash cans with lids in bathrooms. 2. No fit testing completed for staff. An exit interview was conducted with Marylou Convocar, Care giver and a hard copy was provided via email along with Appeal Rights due to technical difficulties (printer.)