Routine inspection·August 28, 2022

Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual required and infection control visit to the above facility. LPA was met with Lisa Sergio, Care giver and later spoke and met with Matt Palmer, Administrator and the purpose of today’s visit was explained. There are currently (5) residents in the facility . (0) residents are ambulatory, (5) are non-ambulatory, (0) bedridden. The facility is a single-story structure located in a residential neighborhood. It consists (6) bedrooms, (2) full bathrooms, 1/2 bathroom, egress system in all exit doors, The facility has ramps along the outside 4 walls of the facility, shaded back yard, side patio, front yard, laundry room and attached 2 garage. LPA and Lisa toured the entire facility inside and out. The facility converted part of garage for staff quarters, (Per administrator room already existed when the facility was bought. It is not part of the facility sketch, administrator to send copy of permits.) Bedrooms 1-5 are occupied by residents and contain the mandated furniture. Bedroom 6 is a staff bedroom. The (2) bathrooms are clean and operational. 1/2 bathroom is a staff bathroom. First aid kit is fully stocked with manual; smoke detectors and carbon monoxide detector were in compliance and operational. No firearms are stored at facility and 1 water fountain outside of side patio, which does not pose a hazard for residents. Medications are stored, locked and inaccessible to residents. (1) Resident file along with medications are current. (1) Staff file is current. Ample supply of perishable and nonperishable food, hot water temperature is 105.3) degrees Fahrenheit, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents, (1) fire extinguisher is fully charged. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair. During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry & visitors and temperatures are logged and checked, sanitizer/soap, paper towels, in all the bathrooms and additional sanitation supplies are stored in the garage. LPA observed staff wearing masks, resident private rooms will be converted to isolation rooms (if needed) trash cans with lids, cart for PPE’s, mitigation plan posted and/or in folder, Fit testing completed for staff, and required postings throughout the facility. Visitor designated area, facility has internet & Crome book for residents to use, resident’s temperatures are checked and logged (once a day). Emergency contacts updated and posted; PPE's are enough for 30 days.Staff and Resident are fully vaccinated. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA observed the following deficiency and issued a citation. See 809D Technical Advisory (TA) issued: 1. No fit testing completed for staff. An exit interview conducted with Matt Palmer, Administrator and a hard copy of report provided.