Routine inspection·December 7, 2022

On 12/7/2022, 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 the facility, spoke with Staff Catherine Espino (S1) and conducted a risk assessment. 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 six (6) non-ambulatory, of which one (1) may be bedridden. Hospice waiver for six (6) residents. LPA met one staff (S1) but did not observe any resident during today's visit. Staff Espino confirmed the facility does not currently have any residents in care. Facility Annual Fees are current during today’s visit. During the visit, LPA toured the facility with S1. This facility consists of four (4) resident bedrooms, three (3) bathrooms, kitchen, living room, dining area, office area, staff bedroom adjacent to the living room, shaded patio (located in the backyard), and a garage. Operable smoke detectors in bedrooms were observed except for one smoke detector in the hallway that does not have a battery and a cover. One operable carbon monoxide detector located in the hallway by the main entrance door is operable. One fire extinguisher last serviced on 4/16/2022 is located in the kitchen. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, and toxins were stored and not accessible to clients. The kitchen was inspected and there is sufficient perishable and non-perishable food available. There are no pools or bodies of water on the premises. There are no firearms on the premises and other dangerous weapons. Potentially dangerous items are kept inaccessible to residents with dementia. The Report Continued in LIC 809-C first aid kit has all required supplies. Toxic chemicals are locked in a cabinet in the kitchen. The facility has a written emergency disaster plan posted in the living room. The facility is maintained at a comfortable temperature. LPA observed hot water temperature in the common bathroom measures 116.5 degrees Fahrenheit. There are working lights or lamps in each room at the time of visit. There are grab bars for each toilet and shower in the resident bathrooms. Showers have non-skid mats. A working telephone 310-212-0883 remains available. During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for residents, staff and visitors, and sanitizing stations in common areas and restrooms. LPA observed S1 was wearing a face covering, LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has an approved Mitigation Plan Report on file with CCLD. Deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiency may result in a civil penalty. Exit interview conducted and appeal rights discussed. A copy of this report and appeal rights provided to Staff Catherine Espino.