Routine inspection·January 28, 2023

On 01/28/23, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit with a primary focus on Infection Control measures using the CARE Inspection Tool. LPA met with administrator Najma Shaheen and explained the purpose of today’s visit. The facility is licensed to operate for twelve (12) elderly non-ambulatory adults of which four (4) may be bedridden. The facility is approved for six (6) hospice residents. Currently, seven (7) resident are DHS and (2) are private pay. The facility is a single-story structure located in a residential neighborhood. It consists of the following: (8) resident's rooms, (4) common bathrooms, a living area, a dining area, a kitchen, and an outside patio area. LPA and administrator toured the physical plant. There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident 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 hot water temperature was tested at 108.1 F. A comfortable temperature of 71 degrees was maintained in the facility. LPA observed the facility to be appropriately furnished at the time of visit. Storage areas for personal hygiene, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. The facility has several fire extinguishers that were charged, smoke detectors, and carbon monoxide was operable. A working landline telephone remains available. The facility has a current liability insurance effective 0801/2022 – 08/01/2023. Evaluation Report Continues on LIC 809-C INFECTION CONTROL: During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed staff wearing face coverings, LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. A review of the resident's and staff's vaccination records was conducted. The facility has a Mitigation Plan Report on file with CCLD and an Infection Control Plan. DEFICIENCY: Based on record reviews, LPA identified the following staff #2, #, #4, #5 and #7 all did not have active CPR/First Aid or CPR/First Aid Certificate on file. LPA identified staff #3 did not have a health screening LIC 503 and a TB test. LPA observed the lower kitchen drawer missing a cabinet handle and room #6 had peeling ceiling plaster. Based on interviews, observation, and record reviews the licensee violated the California Code Regulations (CCR) of Title 22, Division 6, Chapter 8, Deficiency are issued and an exit interview is conducted with Najma Shaheen. A copy of this report, appeal rights, and civil penalty were provided.