Routine inspection·August 11, 2021

On 8/11/202, 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. At around 9:12 am, LPA Montoya called Administrator Teresita Bautista 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. LPA met with Administrator Bautista and Staff Joel Morales and they toured the inside and outside grounds of the facility. The facility is licensed for six (6) non- ambulatory, of which four (4) can be bedridden; approved hospice waiver for four (4) residents. LPA observed five (5) residents and 4 staff including the administrator during the visit. During the tour, LPA observed the facility’s infection control practices. LPA did not observe a sanitizing station at the facility entrance, temperature checks and daily routine symptoms screening log of staff, residents and visitors; visitors log was observed. 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 areas are the resident’s bedroom and the back patio. LPA observed staff, residents, and visitors maintain 6 feet physical distancing, and each person wears a face covering. LPA observed required postings throughout the facility. A review of vaccination records was conducted; four (4) out of five (5) residents and all five (5) staff have been vaccinated with Covid-19. None of the staff have completed the N-95 fit testing. Per Staff Joel Morales, the facility staff received an Infection Prevention and Control training from the Department of Public Health in January 2021. Two (2) out of five (5) residents have memory care needs. Potentially dangerous items, including sanitizers, are kept inaccessible to residents with dementia. LPA observed the auditory devices in resident bedroom #2 and the sliding door in the living are not operable. 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. LPA observed a fruit fly in the resident bedroom #1. 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 136.8 degrees F. A comfortable temperature was maintained in the facility. Smoke detectors are interconnected and operational. LPA did not observe a carbon monoxide detector anywhere in the facility. 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. LPA observed about about five to seven fruit flies in the kitchen. Centrally stored medications were observed stored in their originally received containers and kept safe and locked and inaccessible to clients in care. The First Aid kit was available. Two fire extinguishers last serviced on 4/12/2021 were observed in the dining area and the hallway near the bedrooms/bathroom. Outside grounds were toured, and no bodies of water were observed. LPA observed potential hazards obstructing the walkways such as unrolled garden hoses, an old cabinet, cleaning supplies (brooms and pails) chairs, bicycle, etc. 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 Staff Joel Morales.