Routine inspection·August 4, 2021

On 8/4/2021 at 9:35 am, 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 and, spoke with Administrator Angelique Gradney and conducted a risk assessment. Based on the assessment, the facility is clear of Covid-19 infection. The facility is licensed for six (6) non-ambulatory residents. At around 9:50 am, LPA met with Caregiver Marian Manalang and they both toured the inside and outside grounds of the facility. At around 10:53 am, Administrator Angelique Gradney joined and assisted with the visit. LPA observed the facility’s infection control practices. LPA observed a sanitizing station at the facility entrance and visitors log. PPE supplies are readily available to staff, and an additional 30-day supply of PPE; sufficient paper, cleaning, and disinfecting supplies were observed. The facility’s designated visitation area is the front patio, back patio and the living room. LPA observed staff and residents maintain 6 feet physical distancing, and each staff wears a face covering. Based on LPA’s record review and interview with the Administrator, all four residents and four out of five staff have been vaccinated; N95 Fit testing has been completed and facility staff have been given training on Covid-19 Infection Control and Prevention training. 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. 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 and the shower was free of Report continued in LIC 809C mold/mildew. The water temperature was measured at over 120 degrees F in all three bathroom used by residents. A comfortable temperature was maintained in the facility. All bedrooms and living room have smoke detectors and they are all interconnected and operational. Carbon monoxide detector located between the kitchen and the dining area was observed. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. The First Aid kit was available. Outside grounds were toured, and no bodies of water were observed. Walkways around the home were clear of hazards. Common areas were clean and clear of hazards; doorways were free of obstructions. 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 Angelique Gradney.