Routine inspection·June 25, 2021

On 6-25-21 at 1:00 pm, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced required annual visit with a primary focus on Infection Control measures using the new CARE Inspection Tools. Upon arrival at the facility, LPA Montoya called Administrator Antonia Dionisio and conducted a risk assessment over the telephone. Based on the assessment, the facility is clear of Covid-19 infection. LPA verified that the facility has an approved mitigation plan report. The facility is licensed for three (3) ambulatory and three (3) non-ambulatory. Hospice waiver approved for two (2) residents. At around 1:10 pm, LPA met with the House Manager, Perlita Abilar and they both toured the inside and outside grounds of the facility. LPA was properly screened for Covid-19 symptoms and temperature was checked. Administrator Antonia Dionisio arrived shortly and assisted LPA with the visit. During the tour, LPA observed the facility’s infection control practices. LPA observed a sanitizing station at the facility entrance; visitors log with Covid-19 screening and temperature log, and records of daily Covid-19 screening and temperature checks of residents. PPE supplies are readily available to staff, and an additional 30-day supply of PPE is stored in the garage; sufficient paper, cleaning, and disinfecting supplies were observed. The facility’s designated visitation area is the resident’s bedroom and living room. LPA observed staff and residents maintain 6 feet physical distancing, and each person wears a face covering. LPA observed required postings throughout the facility. At around 2:12 pm , LPA reviewed the facility’s surveillance testing records, all staff are tested once every month. All staff and three out of five residents have been vaccinated. None of staff has completed the N-95 fit testing requirement. Covid-19 Infection Control and Prevention training records and in-service training on the approved mitigation plan were reviewed. REPORT CONTINUED IN LIC 809C All rooms were inspected. Beds in shared bedrooms are 6 feet apart/3 feet head-to-toe apart. Beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed. Furniture in the living room are marked or separated, and 6 feet apart from each other. There are no security bars or weapons on the premises. Resident bathrooms were checked, sufficient liquid soap and paper towels were observed. Toilets and water faucets worked properly, grab bars were secure, the shower was free of mold/mildew, and a non-skid mat was in place. The water temperature measured at 117.4 degrees F. A comfortable temperature was maintained in the facility. All bedrooms and living room have smoke detectors and they are all operational. One operable carbon monoxide was observed. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxins were kept in a locked storage cabinet. The First Aid kit was available. One fire extinguisher last serviced 3/4/2021 is fully charged. Outside grounds were toured, and no bodies of water were observed. LPA observed the following deficiencies: 1. Outdoor chairs are not in good repair. 2. Obstructions in outdoor walkways 3. Ongoing construction which includes painting of the entire exterior part of the home and walkways. 4. Staff #1 is not associated to the facility. Advisory Notes were issued, and Technical Assistance was provided. Deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted and appeal rights discussed. A copy of this report and appeal rights provided to Administrator Antonia Dionisio.