Routine inspection·June 1, 2021

On 6/1/2021 at 9:29 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 Licensee Muqueet Dadabhoy and conducted a risk assessment over the telephone. Based on the assessment, the facility is clear of Covid-19 infection. The facility has an approved mitigation plan report. The facility is licensed for six (6) ambulatory residents, of which six (6) may be bedridden and an approved hospice waiver for six (6) residents. Currently, present in the home are two non-ambulatory and four ambulatory residents of which one resident is in hospice care. At around 9:45 am, LPA met with the House Manager, Virgilio Pascual, and they both toured the inside and outside grounds of the facility. LPA was properly screened for Covid-19 symptoms and temperature was checked. The licensee Muqueet Dadabhoy and assistant administrator Edilberto Bernardino arrived later and joined the visit. During the tour, LPA observed the facility’s infection control practices. LPA observed a sanitizing station at the facility entrance; visitors log with Covid-19 screening and temperature log, and records of daily Covid-19 screening and temperature checks of residents and staff. 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 area is the back patio in addition to the resident’s bedroom. LPA observed staff maintain 6 feet physical distancing, and each person wears a face covering. LPA observed required postings throughout the facility. LPA reviewed the facility’s surveillance testing records, the last Covid-19 test for staff was conducted in March 2021 and discontinued the surveillance testing. A review of vaccination and N-95 Fit Testing records was conducted. All staff and residents have been vaccinated with Covid-19. None of staff has completed the N-95 fit testing. The facility has not conducted a Covid-19 Infection Control and Prevention training to any staff. An emergency contact list was reviewed. REPORT CONTINUED IN LIC 809-C All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed. Furniture in the living room are separated, and 6 feet apart from each other. 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 was measured at 117 and 113 degrees F in the common bathrooms. A comfortable temperature was maintained in the facility. At around 9:55 am, 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. Centrally stored medications were observed stored in their originally received containers and kept safe and locked and inaccessible to clients in care. LPA observed residents' vitamins/PRN medications without prescriptions and labels. The First Aid kit was available. One fully charged fire extinguisher last serviced 4/27/2021 was observed in the kitchen. At 10:14 am, LPA observed a missing smoke detector in resident bedroom #1 and no carbon monoxide was observed. Licensee installed a surveillance camera in common areas without prior notice to CCLD. 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. Due to technical difficulties, advisory notes, citations and appeal rights will be emailed to the licensee by end of business today. An exit interview was conducted, and a copy of this report was provided to the House Manager, Virgilio Pascual.