Routine inspection·November 30, 2022

On 11/302022, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA called to conduct a risk assessment and spoke with Vatche Khedesian who confirmed the facility is free of Covid-19 infection. LPA met with House Manager Victoria Martinez and explained the purpose of today’s visit. The facility is licensed for six (6) non-ambulatory residents, with a Dementia Care Program and an approved hospice waiver for two (2) residents. Currently, there is one (1) Hospice resident present during today’s visit. The facility is a single-story family home located in a residential neighborhood. The facility consisted of the following: Living room, dining area, kitchen, three (3) bedrooms, two (2) bathrooms, laundry area in the garage, indoor/outdoor activity area, shaded patio area, and attached two (2) car garage. LPA Montoya toured the facility with House Manager Martinez. There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for client personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 119.6 degrees Fahrenheit. A comfortable temperature was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharp objects were stored and not accessible to clients. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. There are three (3) fire extinguishers fully charged, one in the kitchen, and two in the hallways to resident bedrooms, smoke detectors and carbon monoxide were operable. Evaluation Report Continues on LIC 809C During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings, LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA Montoya requested a copy of the facility's liability insurance emailed to lourdes.montoya@dss.ca.gov. Technical Advisory was issued. 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. LPA observed and took photos of three large blue trash bins and five large gray trash bins stored along the right side yard pathway from the front yard to the backyard of the facility. The facility sketch shows this pathway must be always clear. LPA also observed Staff #1 is not associated to the facility. Exit interview conducted and appeal rights discussed. A copy of this report and appeal rights provided to House Manager Victoria Martinez.