Routine inspection·January 27, 2022

Licensing Program Analyst (LPA) Luis Mora conducted an unannounced annual visit using the Infection Control Evaluation Tool. LPA met with Caregiver Rodrigo Celesios and explained the reason for the visit. The Administrator Toby Miclat arrived a few hours after. The physical plant was toured, resident files and medication records were reviewed, staff files were reviewed, and food supply was inspected. Facility is licensed to serve 5 non-ambulatory residents and one bedridden ages 60 and above and may retain two hospice resid ent s. LPA and Caregiver Rodrigo Celesios toured the facility which included the following: 5 resident rooms, 1 caregiver room, 1 resident and 1 staff bathroom, living room, kitchen, dining area, and laundry room. The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area for the residents located in the backyard. Passageways and exits are free of obstruction. Auditory devices were seen on exit doors which are required for dementia residents and were operating at the time of the visit. The water temperature was tested in both bathrooms and both measured at 117 degrees F which is within the required 105 - 120 degrees. The bathrooms are clean and have the required grab bars in the shower and near the toilet for non-ambulatory residents. Showers also have non-skid materials. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have enough closet space. Resident beds have the required linen and the linen is in good condition. There is a cabinet in the hallway with extra clean linen and towels. Smoke detectors were observed in each room and throughout the facility and are properly operating. There is a carbon monoxide in the dining area, and it is properly operating. There are 2 fire extinguishers located in the hallway and caregiver room which are fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps are kept locked in the laundry room and are inaccessible to residents. Cleaning supplies and toxins are locked under the kitchen sink and are inaccessible to residents. First Aid kit was fully stocked with current manual and it is kept locked in the resident medication closet in the hallway. (CONTINUED TO LIC 809C) Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing. A supply of 30-day Personal Protective Equipment (PPE) was observed in the facility. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. Resident medications, files, and staff files are centrally stored in a locked closet in the hallway. All six of the resident files and medications were reviewed and no deficiencies were found. Medications are documented properly and given as prescribed. Four staff files were reviewed and a deficiency was found. Staff 1 (S1) and Staff 2 (S2) did not have a health screening in their files. Per California Code of Regulations, Title 22, and California Health and Safety Code, there is deficiencies observed during the visit (Refer to LIC 809D). Exit interview held and a copy of the report and appeal rights was provided