Routine inspection·June 9, 2021

On 6/9/2021, 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 Administrator Bessie Coello and conducted a risk assessment over the telephone. Based on the assessment, the facility is clear of Covid-19 infection. LPA verified that the facility has an approved mitigation plan report. The facility is licensed for six (6) ambulatory residents, of which five (5) may be non-ambulatory, one (1) may be bedridden and an approved hospice waiver for two (2) residents. Currently, there is one (1) Hospice resident present during today’s visit and one on duty staff. There are four (4) out of five (5) residents with memory care needs. LPA met with the House Manager Cynthia Campos and they both toured the inside and outside grounds of the facility. LPA was properly screened for Covid-19 symptoms and temperature was checked. Licensee arrived later and joined LPA with 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 required postings throughout the facility. Covid-19 Infection Control and Prevention training records and in-service training on the approved mitigation plan were reviewed. An emergency contact list was reviewed. 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. Potentially dangerous items, including sanitizers, are kept inaccessible to residents with dementia. 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 118 degrees Fahrenheit. A comfortable temperature was maintained in the facility. Outside grounds were toured, and no bodies of water were observed. The First Aid kit was available. One fire extinguisher last serviced 6/24/2020 is fully charged. Operable smoke detectors in all bedrooms, hallways and common areas with carbon monoxide were observed. Knives and toxins were kept in a locked storage cabinet Advisory Notes were issued, and Technical Assistance was provided. LPA observed the following deficiencies: At around 9:37 am, LPA observed a disrepair closet accessible to residents. The closet floor and ceiling have large holes and the wall has small holes. At around 9:39 am, LPA observed nonprescription medications are not labeled. At around 9:43 am, LPA did not observe a minimum of two-day supply of perishable and a seven-day supply of non-perishable foods. At around 9:48 am, LPA observed items in the sideyard and backyard that are potential hazards to residents. 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 Administrator Bessie Coello. An exit interview was conducted, and a copy of this report was provided to Administrator Bessie Coello.