Routine inspection·November 19, 2021

Licensing Program Analysts Ana Soto and Jey Cardenas 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, LPAs met with caregiver staff Mila Santos, House Manager; the facility is clear of Covid-19 infection. LPAs explained the purpose of todays visit. The facility is licensed for six (6) non-ambulatory residents over the age of 60, hospice waiver approved for four (4). LPA and staff toured the inside and outside grounds of the facility. The one story residential house consists of five (5) resident bedrooms, four (4) resident bathrooms, dining area, and kitchen, laundry area in the garage, and a shaded patio area, backyard. During the tour, LPA observed the facility’s infection control practices. LPA verified that the facility has an approved mitigation plan report. LPA observed a sanitizing station outside near the facility entrance; PPE supplies are readily available to staff, and an additional 30-60 day supply of PPE was observed in the garage area. Sufficient paper, cleaning, and disinfecting supplies were observed. The facility’s designated visitation area is the shaded backyard or front patio area. LPA observed all staff wear a face covering. LPA observed required postings throughout the facility. Bedrooms were inspected, Beds and bedding supplies were in good condition, adequate lighting provided. 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, the water temperature measured at 109.6 degrees F in bathroom. Comfortable temperature was maintained 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. Centrally stored medications were observed stored in their originally received containers and kept safe and locked and inaccessible to residents in care. One (1)Carbon Monoxide and interconnected Smoke Detectors were tested, and in operating condition. The facility has one (1) Fire Extinguisher, which was checked and found to be fully charged and accessible.. The First Aid kit was available and fully stocked. There are no security bars or weapons on the premises. LPA checked staff and resident file and reviewed medication. On 11/19/2021 at approximately 10:42am LPA observed over the counter medication: Calcium, D3, C, Multi-50+ vitamins, aspirin, and allegra for Resident#1 (R1), medication bottles didn’t have prescription label. 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. No bodies of water present. Advisory Notes with technical assistance were issued: 1. Ensure all staff are fit tested for respirators. 2. CCLD provider information notices (PINS) shall be posted and available to residents/ staff. 3. Facility shall take and document residents & staff temperature & screen for covid symptoms. 4. Isolation room postings shall be available in the event of a Covid-19 positive case. A deficiency was 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 facility representative, _Mila Santos.