Routine inspection·November 9, 2022

On 11/9/2022, 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 Michelle Kellogg and conducted a risk assessment over the telephone. Based on the assessment, the facility is clear of Covid-19 infection. LPA met with House Manager Ricardo Bernal and explained the purpose of today's visit. The facility is licensed for two (2) ambulatory and four (4) non-ambulatory, of which two (2) may be bedridden. Facility has two approved hospice waivers. LPA observed six (6) residents and two (2) direct staff present during today's visit. Staff Kian Pascual arrived later and joined the visit. The facility has an approved mitigation plan. LPA Montoya toured the inside and outside grounds of the facility with House Manager Ricardo Bernal. During the tour, LPA observed the facility’s infection control practices. LPA observed a sanitizing station at the facility entrance and a visitors log. PPE supplies are readily available to staff, and an additional 30-day supply of PPE is stored in a cabinet in the hallway; sufficient paper, cleaning, and disinfecting supplies were observed. 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. 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. REPORT CONTINUED IN LIC 809C The water temperature measured at 107.0 degrees Fahrenheit in the common bathroom and 106.0 degrees Fahrenheit in the shared bedroom. A comfortable temperature was maintained in the facility. All bedrooms and living room have smoke detectors and they are all interconnected and operational. Carbon monoxide detector located and mounted in the hallway is operational. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives 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. The First Aid kit was available. Two fire extinguishers last serviced 2/10/2022 are fully charged. Outside grounds were toured, and no bodies of water were observed. Advisory Notes were issued, and Technical Assistance was provided. LPA observed the following deficiencies: · Dishwasher is not operable. · Black side gate is rusted and broken. 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 Staff Kian Pascual.